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Full text of "Peoria Medical Monthly (1880-1891)"

Vol VIII. -i- Januiary, 1S88 



.^ 



No, 



'picpx) 




A PRACTITIONER'S JOURNAL. 



TH05 M. MciLVAINE, A, M.. M. D., Editor, 



TRANiSCRIPT PUBLISHING CQ, 

'UBusne/tt. 



© 



TWO DOLLARS PER ANNUM. IN ADVANCE. 



o o 3sr Ti±iisrTs 



OKIcmAI, COMMUNICATIONS. 

N^ph.rtt■tomy — A Case 

C^as. T. Parkes, M. D. 30.5 

^bperiosteal Resection of a Rib lor Em- 
pyenjft in Cliildren — Recovery . . . 

■ . ■ A. B. Strong, M. D. 317 

Vaginal Hvsterectomy, Report of lliree 
0.*sfs J. H. Ethfridse, M. D. 308 

SOCIETY TRANSACTIONS. 
Thieago Medical Society: 

Vaginal Hysterectomy 320 

Treatment of Pertussis 321 

Nephrectomy 1^21 

SKLECrED ARTICf.:^. 

Bjplitlieria in Private Practice ;^27 

Epididymiiifi »nd Orchitis 326 

I^oetid Corvza « \:i^ 



33® 



332 



Svibstitiite for the Orthodox Pessary . 

Comedones, Treatment of 3-3.1 

KDITORIAI,. 

A Contemptible Practice 

Why there are so Many Medical Jouruals, 

Druggists as Doctors 334 

Editorial Mention: 

Changes in the Rush Faculty 335 

Death of Dr. Carpenter 3J5 

State Society fleeting ■^t^ 

NoTRs A?ir> N'«ws Items . .■ ^fc 

PKRISCOPR. 

Fecal Auieniia ^% 

Hyper-emesis 317 

Salol in Typhoyd Fever 3^ 

Sudden Deatli after Uretliral lajeetioa . . 3.^7 

Strange Scenes at a Fire 338 

Ptjbi.ishbr'sDkpaktmbnt, tdv'ng pp. . ?3-r3 



ADVERTISEMENTS. 



Artificial Liv:;'js .... 16 

flattie ^' Cg . '"■ ■ ' ; 5 

Bush Mar ifacl'' lag Co 25 

Caulocore. 20 

Colden's Lict.^d Beef Tonic (cover) 4 

Cincinnati Sanitarium 21 

Cottage Hospital ig 

Crystalline Phosphate 20 



Dr. Mclntotli Natural Utei'ine Supporter 
Kli Lilly & Co 



18 



For Sale (cover! 2 

For Sale 17 

Fellow's Hjpophospbites (cover) 3 

Fairchild Bros. & Foster . "i 

Gate Citv Stone Filter Co 14 

Griffith & Co 19 

H. Krnse. M. D 17 

Hanny's Phy.sician's Road Cart 6 

Jerome Kidder Mnfr'g Co 24 



Lambert Pbarniacal Co. i cover 1 4 

Memory Discovery 17 

Mari«ni & Co (cover) 2 

New York Phar:n«cal Awociation 2 

Oxygen Apparatus 14 

Peacock's Bromides ; .... 24 

Parke, Davis .<s: Co g 

Planten'i Capsulei 6 

R. K. Robinson & Co 3 

Rio Chemical Co 4 

Rush Medical College 15 

Roberts and Fellows 17 

Scott & Bowne »6 

Shoes for the Lame 21 

■'Sunnyside" Private Home l5 

Tucker'e Ihirnitnre 6 

Wheeler's Tissue Phosphates a6 

W. R. Warner & Co. (insert) .... 9-10-II-12 
W^ H. Schieffeliu & Co 13 



Hnterert at th PostofRce at Peoria. 111., 8» Serond CIsm Matter, 



COMMTOICAIIOH mU Sill MOEBLL MACKBH2IB. 



19 Harlev Street, Cavendish Square, W., London. 

Gentlemen: I have much pleasure in stating that I have used the Vin 
Mariani for many years, and consider it a valuable stimulant, particularl}' ser- 
viceable in the case of vocalists. Yours faithfull}', 

MORELL MACKENZIE, M. D., London. 

Consulting Physician lo the Hospital for Diseases of the Threat; late Physician to the Loudon Il:>S5)itar 



The above emiiieut opinion W3 use only in the endeavor to further 
popuhirize among the medical profession a standard preparation, which, 
when pubjected to an impartial test, will prove its real value and une- 
qualled high standing. 

The only (Joca Preparation endorsed by the Academie de Medicine 
q{ France. 

Used in the HoS})italr-, Cliniques and Public Institutions throughout 
Kiu'ope, and by the Alodical Profession, since 1863. 

Invariably uniform in its results. 

As a strengthener of the nervous system, with especial good effect on 
the respiratory and digestive organs, it is pronounced the remedy jxjr 
excellence. 

Owing to the large demand for Vin Mariani, imitations and substitu- 
tions are being forced on patients where physicians do not especially 
specify 



liiMlRlM 



And we would respectfully call attention to this fact, as being the cause of 
failure to secure good effects in many cases where Coca is prescribed. 

^^^ TREATISE, 53 pages, with detailed description, Jormula, dose, etc. 
[translated from the French), will be sent gratuitously and post-paid to any 
Physician mentioning this Journal- 

Price for Vin Mariani is reduced; and where druggists do not keep 
it, we will supply it to patients by the case of twelve bottles for twelve 
dollars. 

Remittance in all cases must be sent with the order. 

To Physicians, for their own use, a discount will be made. 



MARIANI & CO., 



PARIS, 

41 Boulevard Haussman. 



127 FIFTH AVENUE, 

NElXr YORK. 



CORRESPONDENCE FROM PHVSICIANS SOLICITED. "^W 



Advertisements. 



ESSENCE OF PEPSINE 



(FAIJiCHILD.) 



A Solution of the Essential Organic Ingredient of 

the G-astric Juice, Extracted Directly from the 

Pe-otic G-lands of the Stomach. 



This Essence of Pepsine is highly recommended where a fluid and 
agreeable form of pepsine is desired. It is especially eligible for admin- 
istration to infants in vomiting and indigestion. It contains but a slight 
trace of acid, not perceptible to the taste; whenever this u indicated the 
proper acid can be added, and in the amount required. The very decided 
acidity invariably found in the ordinary wines, elixirs, etc., ot pepsine, is 
of very questionable utility therapeutically. It is certain that there are 
cases, especially of children, in which acid is not only undesirable, but 
positively hurtful. 

A teaspoonful just before or after food will be found to aid digestion 
and assimilation; also, recommended at any time when suffering from 
indigestion. In the occasional distressing attacks to which chronic dys- 
peptics are subject, a few doses will afford the most happy relief. 



Faircliild Bros, i Foster, 

82 and 84 Fulton St., New York. 



Advertisements- 



>5i^ 



- <«'C'lSB_i* ** i>f^'M^i*ii*i pr-cpci/rc^ cotntmatioiv of 9tleat-co-n.vettivKj, Sfat- coi^uc«4> 
J.Q^i^**'''' *'^>'J <»^^ Stai>c-fv-c-onuctti-n<j 91lat<stiafc, acti)ifici> luitft t<Vc Awiatt propottiow 
' v^^ «f Clcvo* afiuai^s f>zt^>cwt U\ tfie freaftAij stoMiacfi. 3t tA a most oafvtatfe ^ttg^stma 
ag*Mt, en4> SUPERIOR TO PEPSIN ALONE."- Prof. Attfield, Ph. D., F.R.S., &c., 
Prof, of Practical Chetnistry to Pharmaceutical Society of Great Britain. 




LACTOPEPTINE ! 

The Most Important Remedial Agent Ever Presented to the Profession for 
DYSPEPSIA, VOMITING IN PREGNANCY, 

CONSTIPATION, and All Diseases Arising from Imperfect Nutrition. 



Lactopeptine in Cholera Infantum. 

We desire to direct special attention to the great value of Lactopeptine in 
Cholera Infantum, and other intestinal troubles incident to the heated term. 

Send address for our Medical Almanac, containing valuable information. 



The New York Pharmacal Association, 



p. O. Boxi:i574. 



NEW YORK. 



Advertisements. S 

Thete preparationi may be relied upon as betng accurately and skilfully prepared, 

from iTie best materials. 

ROBINSON'S HYPOPHOSPHITES. 

Nutritive, Tonic and Restorative, palatable and agreeable. 
Each fluid ounce contains: 

HYPOPHOSPHITE SODA 2 grs. 

LIME U " 

IRON li " 

QUININE J " 

MANGANESE U " 

STRYCHNINE 1-16" 

DOSE: I to 4 FIdrs. 

The efficacy of such a combination of remedial agents in the treatment of pulmonary weakness, or any form of 
debiility, has been clearly demonstrated. la CoNSDiiPXiON and other wasting diseases and in sthumous affections 
it has proved invaluable. In pint boitles. Price, SI. 00. 



ROBINSON'S WINE OF COCA. 

The stimulant virtues of the best select grade of Coca Leaves are represented in this preparation combined with 
a very fine article of pure Imported Malaga Wine. It is recommended in cases of nervous prostration, general 
debility etc. 

Each fluid drachm equals 7 K grains Coca Leaves. Dose: 1 to 8 Fldrs. In pint bottles. Price, fl(1.00> 



ROBINSON'S LIME JUICE AND PEPSIN. 

An elegant preparation, combining the reliable digestive properties of Scheffer's Concentrated Pepsin, and the 
Aperient and Cholagogue character. sties of Pure Lime Juice of the best quality. 
A valuable remedy for Dyspepsia, Indigestion, Biliousness, <i;c. 
Each fldr. digests at least loo grs. albumt n; for specific test see label. 

DOSE, I to 4 FIdrs. 

In 6 oz. Bottles Price 50c. 

In Pint Bottles " 81.00. 



ROBINSON'S PHOSPHORIC ELIXIR. 

A MODIFIED AND IMPROVED FORM OF 

CHEMICAL FOOD. 

Each fluid ounce represents: 

PHOSPHATE SODIUM 12 grains 

POTASSIUM 4 " 

CALCiUM 4 " 

IRON 2 " 

FREE MONOHYDRATED PHOSPHORIC ACID 16 " 

Therefore is approximately equal to thirty (.30) grains of Monohydrated Phosphoric Acid, /ree and combined. 

Equal in therapeutical value to the old reliable Parrish Chemical Food, or any similar combination of Phosphates, 
and in elegance of appearance and palatability far superior. The full benefit of Phosphoric Acid and the above 
named Phosphates as a remedy tor Nervous Exhaustion, General Debility, Deranged Digestion, Renal Troubles, etc., 
wiU be derived from oar ^'Phosphoric Elixir." 

DOSE: 

The average dose is a dessertspoonful (2 fldrs.) diluted with water to be taken immediately before, daring or 
after meals. In Pint Bottles, Price Sl.OO. 



May be obtained through retail Druggists. If the Tiearest druggist is not supplied, we vnll forward for trial, either ar- 
ticle by Express prepaid upon receipt of the retail price. 

We invite a trial of our preparati07is. Please specif y ROBINSON'S. We are confident you unit be pleased with them. 

R. A. ROBINSON & CO., 

Manufacturing Pharmacists, 

Established 1842. LOUlSViile, Ky. 

For Sale by Druggists in Peoria. 



ftmm«m«««mm««m«m%««mm«m«%'W».m%mm%%mm«mmmm«mmm«mm«mmmm%m«mmmm«mmm«%%mmmmmmf 



I 



CSELERINA 



NERVE-TO NIC, STIMUL AN T AND ANT ISPASMODIC. 

FORMULA.— Every Fluid-Drachm represents FITE grains EACH — Cel- 
ery, Coca, Kola, Tiburunm and Aromatics. ^' 

INDICATIONS.— Inapotency, Spermatorrhea, Loss of Nerve -Power (so 
usual with Lawyers, Preachers, Writers and Business Men), Nervous Headache, 
Neuralgia, Paralysis, Dysmenorrhea, Hysteria, Opium-Habit, Inebriety, Pros- 
tatitis, Dyspepsia, and ALL LANGUID or DEBILITATED conditions of the 
System. — Indispensable to restore a patient after alcoholic excess. 



ALEtmS CORDIAL 



UTERINE TONIC AND RESTORATIVE. 



where abortion is feared, the Aletris Cordial is indieated, and should be con- j 

tinuously administered during entire gestation. J 

I 

A MILD, SAFE AND PL EASANT AP ERIENT. ^ 

Prepared from Manna, Purified Cafharfic Acid, and Fruif Juices. ^^^ g 

INDICATIONS. — Constipation, Biliousness, Congestions, Etc. INDIS' ^ 

PENSABLE AS AN aperient fob women during PREGNANOi. In J 

teaspoontul doses, 3 times a day. it favors the SECRETION and EXCRETION S 

of bile, and gradually removes the congested and torpid states of the liver, 8 



PREPARED FROM THE ALETRIS FARINOSA OR TRUE UNICORN. 

Leucorrhea, 



Prolapsus 



INDICATIONS. — Amenorrhea, Dysmenorrhea, 
Uteri, Sterility, to PREVENT Miscarriage, etc. ' 

DOSE.— One teaspoonful three or four times a day. 

Unrivaled as a Uf erine Tonic in Irregular, Painful, Suppressed 1 Excessive Menstruation 

IT RESTORES NORMAL ACTION TO THE UTERUS, AND IMPARTS YIGOE TO 
THE ENTIRE UTERINE SYSTEM. 



AGIO IVIAN NATE 



and keeps the bowels in a regular and soluble condition. 

DOSE.— ONEor MOREteaspoonfulsas directed by he Physician. 



S.H.KENNEDYS 

CONCENTRATED EXTRACT OF 

PINUS CANADENSIS 

! A NON-ALCOHOLIC LIQUID. |white 



A MOST VALUABLE NON-IRRITATING MUCOUS ASTRINGENT. 



INDICATIONS.— Albuminuria, Diarrhea, Dysentery, Night-Sweats, Hem- ,-, 
rhages. Profuse Expectoration, Catarrh, Sore Throat, Leucorrhea, and other 



Vaginal Diseases, Piles, Sores, Ulcers, Burns, Scalds, Gonorrhea, Gleet, Etc. 

When Used as an Injection, to Avoid Staining of ^'X^n, the WHITE Pinus should be Used. 

Becommended by DR. J. MARION SIMS, and other Prominent Physicians. 



LONDON. 






PARIS 



Samples FREE to any Physician who will pay Express charges, and mention this Journal. 



toJ) 



Advertisements. 

BROMIDIA 

THE HYPNOTIC. 

FORMULA. — Every fluid drachm contains 15 grains 
EACH of pure Chloral Hydrat. and purified Brom. Pot. and 
I gr. EACH of gen. imp. ext. Cannabis Ind. and Hyoscyam. 

DOSE.— One-half to one fluid drachm in WATER or 
SYRUP every hour until sleep is produced. 

INDICATIONS. — Sleeplessness, Nervousness, Neural- 
gia, Headache, Convulsions, Colic, Mania, Epilepsy, Irrita- 
bility, etc. In the restlessness and delerium of Fevers it is 
absolutely invaluable. 

It Does Not Lock Up the Secretions. 



THE ANODYNE. 

PAPINE is the Anodyne or pain-relieving principle of 
Opium, the Narcotic and Convulsive elements being elimi- 
nated. It has less tendency to cause Nausea, Vomiting, 
Constipation, etc. 

INDICATIONS. — Same as Opium or Morphia- 
DOSE. — One Fluid Drachm — represents the Anodyne 
principle of ^ grain of Morphia. 



THE ALTERATIVE AND UTERINE TONIC. 

FORMULA. — lodia is a combination of active principles 
obtained from the Green Roots of Stillingia, Helonias, Saxi- 
fraga, Menispermum and Aromatics. Each fluid drachm 
also contains 5 grains lod-Potas. and 3 grains Phos-Iron. 

DOSE.— One or two fluid drachms (more or less as in- 
dicated) three times a day before meals. 

INDICATIONS.— Syphilitic, Scrofulous and Cutaneous 
Diseases, Dysmenorrhea, Menorrhagia, Leucorrhea, Amen- 
orrhea, Impaired Vitality, Habitual Abortion and General 
Uterine Debility. 



CHEMISTS' CORPORATION. 

BRANCHES: ST. "LOXJIS, 3X0. 

76 New Bond St., London, W. 

5, Rue De La Paix, Paris. 

9 & 10 Calliousie Square, Calcutta. 



OS 



crt=^ 



Advertisements. 



MANUFACTURER OF 



CX3 



P*q 
CO 




Turkish Couches, -i- Shaw Adjustable Chairs, 

PHYSICIAN'S ROAD CART. 



R EannY. 



MANUFACTURER. 




COR. MAIN AND HALE 
STREETS, 

I^eoria, 111. 



This Road Cart is free from all horse motion, owing to my improved thills, which are fastened to the cart by 
springs, on which the unpleasant motion experienced in most carts is spent. Nothing but the very best material 
is used. For strength, durability and tysle, it is uneqnaled. All who have used this Road Cart pronounce it the 
very best two-wheeled vehicle made. Before purchasing elsewhere call and examine our Road Carts and get pri- 
ces. Endorsed by Physicians everywhere as the best Road Cart made. 

Address 

I^.. I3:^3Sr3^"Z-^ I^EOI^I^, ILL. 

TAKE ONLY AND INSIST ON "THE BEST OF AMERICAN MANUFACTURE." 
Known as Reliable Fifty Years "For General Excellence in Manufacture." 



ESTABLISHED, 1836. 



HE, 



224 WILLIAM ST., NEW YORK. 

HARD AND SOFT ELASTIC. ALL KINDS FILLED, 

Nine Sizes--3, 5, lOand 15 Min.; and I, 2 l-", 5, 10 and 15 Grammes. 

New Articles Added— OIL OF WINTERGREEN, SANDALWOOD, Pure, SANDALWOOD 

1-10 Cassia, OIL OF JUNIPER, APOIL PEARLS. 

EMPTY— For Powders, 8 Sizes; For Liquids, 3 Sizes. SIZES— Vaginal 6; Rectal 3. 

Improved Empty Capsules, trial box, 25c. Horse Ball (5 sizes) and Capsules for Mechanical Purposes. 
4S~We make all kinds of Capsules to order. New articles and private formulas a specialty. Samples sent free 

Sold by all Druggists. Speclfv PLANTEN'Son all orders. 



Advertisements. 7 

SUCCUS ALTERANS. 

SuCCUS Alterans is a purely vegetable compound of the preserved juices of Stillingia 
Sylvatica, Lappa Minor, Phytolacca Decandra, Smilax Sarsaparilla and Xanthoxy- 
lum Carolinianum, as collected by Dr. Geo. W. McDade exclusively for Eli Lilly & 
Ck)., and endorsed by Dr. J. Marion Sims. 

SuCCUS Alterans continues to gain favor from its remarkable Alterative and Tonic 
properties, eliminating specific poison from the blood and increasing the proportion of 
red corpuscles in ancemic patievhio wonderful degree; is endorsed by the medical pro- 
fession and in use by many hospitals of note. 

SuCCUS Alterans in venereal and cutaneous diseases is fast supplanting Mercury, the 
Iodides and Arsenic; and is a certain remedy for Mercurialization, lodism, and the 
dreadful effects often following the use of Arsenic in skin diseases. 

SuCCUS Alterans is also strongly recommended for its Tonic and Alterative effects in 
myriad forms of scrofulous disease, and in all cases where anaemia is a factor. Such 
patients rapidly develop a good appetite, sleep soundly and gain flesh rapidly. Many 
cases are on record where patients increased ten to twenty-five pounds in weight in a 
few weeks. 

SuCCUS Alterans is giving satisfactory results in treatment of Chronic Rheumatism 
and can be used with confidence. 

SuCCUS Alterans may be given for any length of time, without injury to the patient. 

SuCCUS Alterans is put up in pint round amber bottles and never in hulk. 

Physicians who have not received Dr. McDade's latest publication, the Monographia 
Syphilitica, should send their address, mentioning this journal, and we will mail a 
copy. It contains a paper, illustrated with colored plates, by Dr. D. H. Goodwillie, 
of New York, on the "Sequelae of Syphilis," reports of cases in practice and many other 
valuable papers. 



ELIXIR PURCANS. 

£l.txiB PuBGANS (Lilly) reliably stimulates the dormant liver without undue irritation, and has gentle yet positive 
effect upon the alimentary tract. In Habitual Constipation, so common to women and children it will be found par- 
ticularly useful. Its endorsement at Bellevue and man\ other prominent hospitals east and west, as well as its em- 
ployment in general practice by the most eminent medical men, confirms the experience of years in its use. 
Each Teaspoonful Represents 

IN PRESCRIBING, PLEASE BE CAREFUL TO WRITE 

ELIXIR PURQANS (LILLY) 

That Othee Preparations may not be Sxjbstituted. 



Rhamnus Pu-shiana, - 10 grs. 
Euonymus Atropur., - - 8 grs. 
Caseia Acutifolia (Purif.) 10 grs. 
Iris Versicolar, ----- 4 grs. 
Hyoscyamus Niger, - - 2 grs. 
Aromatics, etc. 



HiG-HLY Recommended. 

We take pleasure in erwiorsing; Elixiti Pubgans (Lilly) as prepared from the above formula, for in it we find a 
near approach to positive perfection in the form of a Liquid Cathartic, and trom our experience with the preparation, 
can highly recommend it to the profes.sion. 

JAM K.S R HEALY, M. D ; SupH Infants' and Children's Hospital. RanddlVs Island, New York. 

W. G, ROBIN.SON, M. D., Surgeon to Bureau of Medical and Surgical Belief to the Out-door Poor, Bellevue Hospital, 
New York. 

J H. SHORTER M. D., Surgeon to New York Ophthalmic and Aural Institute. 

JOHN A. ARNOLD, M. D., JSUdical Stip'l King's County Hospital, Flatbush, N. Y. 

NELSON B SIZEK, vi. U., Senior Surgeon, Brooklyn and E. Brooklyn Dispensary, N. Y. 

EDWARD J. DARKEN, U. D., Medical SupH Demilt Dispensary, New York City. 

A. W. t ATLIN, M. D., Attending Physician, St. John's Hospital, Brooklyn, N Y. 

CHAS. H. COBB, M. D., Medical SupH Volumhus Lying in Hospital, Boston, Mass. 

H.S. DEARING, M !>., Fellow of Massachusetts Medic(d Society, etc. 

T. J BRODRICK, M. D , Surgeon Charlestown, Mass., Free Dispensary and Hospital. 

ELI LILLY & CO pharmaceutical chemists 

*"■"* aJ**J*J* \*/ w., Indianapolis, IND., U. S. A. 

SUPPLIED BY ALL DRUGGISTS. 



Plain Talks to Physicians. 



GELATIN CAPSULES. 



The development of aesthetic tastes has been a most marked accompaniment o( 
the material progress of the people of America. The desire to unite beauty with 
utility is so universally manifested that it was to have been anticipated that it woula 
modify forms of medicine, and this has been the case. To-day the physician who 
fails to recognize and satisfy this demand, however sterling his qualities, will not 
attain practical success. 

The employment of gelatin as a device for the agreeable exhibition of medicines 
has enabled physicians to gratify this universal desire without sacrificing therapeutic 
virtue. The step from empty to filled gelatin capsules was a most natural one, and 
today it may almost be said that physicians might confine internal medication exclu- 
sively to this class of products and be able to meet almost every conceivable indica- 
tion for treatment. 

It has been claimed that gelatin will not dissolve if taken with alcoholic drinks, 
and that on this account the utility of gelatin covered oroducts is limited. Such 
criticism, however does not apply to gelatin of pure qualit>. and it has been shown 
by the experiments of competent authorities that the small proportion of alcohol in 
alcoholic beverages has no more effect in retarding the digestion of gelatin than of 
ordinary foods, and indeed, that gelatin is far more quickly soluble than many forms 
of food. Moreover it is well known that the action of alcohol is twofold, while U 
tends primarily to retard digestion, this tendency is more than compensated for by its 
stimulant effect on the gastric and intestinal digestive secretions. The prejudice that 
properly made gelatin products are insoluble is unfounded. 

When we undertook the preparation of gelatirt- products, we found in the market 
a class of goods of this nature which the reputation of our house would not permit us 
to duplicate. We accordingly set about improving the methods of their manufacture 
and th^ quality of material which entered into their composition. The result is seen 
in the superior appearance and quality of the gelatin products which we now offer 
the profession. For symmetry of shape, beauty of finish, and solubility, our gelatin 
capsules, we believe, occupy undisputed pre-eminepce. 

Of the elastic filled capsules which we commend as the most eligible method of 
administering nauseous and bitter drugs that pharmacy has given to medicine, we 
make 87 formulae. Especially convenient and in greatest demand are elastic capsules 
of quinine, castor oil, cod liver oil, copaiba and cubebs. We trust those of our med- 
ical friends, not already familiar with this class of our products, will send for our 
formula book of capsules, wherein many points are presented which we cannot 
adequately cover in this brief talk. 

Very respectfully yours. 

PARKE, DAVIS & CO., 

Manufacturing Chemists, 

NEW YORK :]^^^^^° Lane and DETROIT MICH. 



The Peoria Medical Monthly. 



Vol. VIII. 



JANUARY, I 



No. 



ORIGINAL COMMUNICATIONS. 
*A CASE OF NEPHRECTOMY. 

BY CHARLES T. PARKES, M. D., 
Professor of Surgery, Rush Medical College, Attending Surgeon to the Presbyterian Hospital, Chicago. 



Last July I received a communica- 
tion from a friend out of the city, stat- 
ing that a patient had come under his 
charge who had been suffering for two 
years with cystitis, the diagnosis being 
based upon pus in the urine. 

When I returned from my vacation 
in September, I found the patient 
awaiting me at one of the hospitals in 
the city. Upon examination it was 
found that a tumor could be easily pal- 
pated in the right side of the body 
beneath the ribs, large enough to ex- 
tend down to the superior spinous pro- 
cess of the ileum, and reaching up to 
the hypogastric region below the liver. 
Upon the usual attempts at palpation 
and percussion, the dulness over the 
tumor was found to be continuous with 
the dulness ot the liver. But the tu- 
mor appeared to me to be so elastic as 
to present some of the characteristics 
of a sac containing fluid. So I intro- 
duced an aspirator needle into it, and 
as was expected, found pus. As it 
presented none of the usual symptoms 
of a perinephritic abscess, it was diag- 
nosticated to be a case of suppurative 
disease of the kidney communicating 
with the bladder through the ureter, 
the bladder being the outlet of the pus. 



There was no apparent disease of the 
bladder itself, other than that which 
would be present as a consequence of 
the foreign substance in the bladder. 

Obtaining the patient's consent to 
an operation, an incision was made 
over the tumor to the outside of the 
erector spinae muscle, and the tumor 
was exposed; then the pockets of pus 
in the organ were located by the hy- 
podermic syringe. On this occasion, 
three pockets of considerable size were 
opened, and drainage tubes introduced. 
About a pint of matter was let out. It 
was decided that these three pockets, 
that were found by introducing the 
syringe in different places, did not 
communicate with each other; they 
were separate cavities, and I think that 
is the usual condition found in this sort 
of disease of the kidneys. 

One of them opened freely into the 
pelvis of the kidney, so that through 
the incision that was made, the finger 
passed into the pelvis, and water in- 
jected into this went into the bladder, 
showing that there was a direct com- 
munication from this cavity of pus to 
the bladder and urethra. The drain- 
age tubes were left in and the patient 
improved promptly, losing the fever 



•Read before tie Chica^-o Medical Society, Novembpr 7. 1887. 



\o6 



Original Communications. 



and symptoms of pus accumulation 
and retention. For two weeks the im- 
provement continued, then it was no- 
ticed that she began to fail rather 
rapidly and to show signs of fever 
again; there were signs of septic accu- 
mulation, and the tumor began to 
increase in size, so that from diminish- 
ing, perhaps half the size when first 
examined, it increased one-third. As 
she was failing and the diagnosis was 
as complete as it was possible to make 
it, it was decided to perform nephrec- 
tomy. 

There are some points of importance 
in the case: The drainage tube that 
went into the pelvis of the kidney gave 
free exit to quite a quantity of urine. 
I think that most of the secretion from 
that kidney came through the drainage 
tube; it was sufficient to wet thor- 
oughly in two or three hours a large 
dressing; this dressing was sufficient 
to keep the discharge from the wound 
pure, so that there was nowhere de- 
composition of pus so far as the out- 
ward manifestations were concerned. 
It struck me that if this drainage tube 
from the diseased kidney gave exit to 
such an amount of urine, and at the 
same time there was a good flow of 
urine from the bladder, it was a fair 
indication that the other kidney was 
not diseased, and that success would 
attend the removal of the diseased kid- 
ney, and it was decided to do the 
operation. 

Sixteen days ago the operation was 
done. The partient was prepared in a 
certain way that I have followed in 
reference to all patients upon whom I 
do what is considered a serious opera- 
tion, and I think it has a certain influ- 



ence in preventing shock. Two or 
three hours before the operation is per- 
formed, the patient is given gt. v. to x. 
of quinine, and gr. y^ of morphine. 
This medicine was administered to the 
patient of whom I am speaking, and 
the operation for the removal of the 
kidney was performed. The whole 
proceeding from beginning to end oc- 
cupied an hour, and she went to bed 
without any manifestation of shock, 
and with a pulse of 112. She had no 
rise of temperature until the second 
day, and then it rose to loo*^; subse- 
quent to that, it fell to noi-mal, and did 
not rise above normal until the twelfth 
day, when other symptoms appeared. 
During all this time the wound was 
absolutely aseptic. It healed promptly 
by first intention, so that on the sev- 
enth day all stitches were removed; 
the wound was solid from one end to 
the other. 

There are some points about this 
operation to which I desire to call your 
attention, and I will pass the specimen 
around to show the nature of the trouble. 
You will see at the lower end a cavity, 
which was found to contain six or eight 
ounces of pus; there is another cavity 
in the interior of the kidney; the pelvis 
is entirely destroyed and filled up with 
adventitious material. 

Here was an operation to be done 
upon a moderately sized woman for the 
removal of a tumor containing pus — a 
tumor which reached up under the ribs, 
down to the crest of the ilium, and for- 
ward to the anterior spinous process. 
There was a tumor containing pus, in 
which large pockets had formed. What 
was the best way to remove it? There 
is no question in mj^mind that the best 



A Case of JVephrectomy 



307 



operation, in general, for the removal 
of the kidneys is the posterior opera- 
tion. However, there are many dis- 
eases for which this operation is done 
where it is impossible to do it in another 
way than the anterior operation — such 
as cases of cystic degeneration, where 
the tumor is so large that it cannot be 
extruded posteriorly; but here was a 
tumor of moderate size, containing pus, 
in which it was desired above all things 
to avoid getting into the peritoneal 
cavity — a tumor which had sacs, the 
walls of which were in moderate de- 
grees of thickness and strength, but 
could easily be broken open on press- 
ure. 

Therefore, the day before the opera- 
tion, I took a cadaver and experimented 
upon the lines of incision which would 
best expose this tumor and give exit to 
it. I finally decided upon the incisions 
represented in Figure i. This repre- 
sents the patient lying upon the oppo- 
site side from the diseased kidney. In 
these experiments I found that by a cer- 
tain incision I could get the amplest 
room without doing injury to the colon 
or peritoneum; certainly no more likely 
to injure the colon, the peritoneum or 
other contents of the abdominal cavity 
than in an operation for the exposure 
of any of the large blood vessels of the 
abdomen. 

It is hardly necessary for me to state 
that there is some little difference be- 
tween subserous tissue in the lower 
portion of the abdomen and that of the 
upper. In the lower portion it is very 
loose and easily separated, whereas at 
the upper portion it is quite thin, and 
the peritoneum is more apt to be torn, 
hence more care should be used in an 



operation in this position. The com- 
mencement of the incision is supposed 
to be two inches above the anterior 
superior spine of the ilium. It is car- 
ried in a curved direction downwards 
and backwards to the tip of the last rib. 
The incision is carried through all the 
tissues, down to the fascia transversalis, 
everything is carried forward out of 
the way, and with the finger the dis- 
section can be made, well behind the 
tumor; all the parts are separated, 
then a straight incision is made through 
all of them, straight back from the first 
incision and half way between the crest 
of the illium and the last rib. The intro- 
duction of a ligature at the point of the 
posterior flaps, and pulling aside, gives 
a wound one can get both hands into, 
and, by exposing the kidney in all its 
parts, reach the tissues which one 
wishes to have under control, without 
difficulty. 





Figure 2. In this case, as soon as 
the incision was made, the tumor pre- 
sented itself, the finger could be carried 



3o^ 



Original Communications. 



around it in all directions, so that the 
kidney, with its blood-vessels, ureter 
and all, were well exposed to view. 

I desired to adopt the plan, which is 
a good one to adopt in all tumors that 
are difficult to reach, of diminishing the 
size of the tumor, and attempted to di- 
vide it in halves by the cautery; but, 
after a few strokes of the knife, I ap- 
proached a pocket of pus, and gave 
that up for fear of infecting the wound. 
I had very little difficulty, by taking an 
eyed probe, threaded with a stout 
double ligature, in passing the probe 
through the centre of the pedicle, and 
then with the double ligature Hgating 
it in halves. The ligatures controlled 
the circulation perfectly. The vessels 
in the exposed stump were picked up 
and ligated one by one as a special se- 
curity. Drainage was perfect, and the 
anterior wall of the peritoneum fell 
easily into place and united by primary 
intention. At the end of a week there 
was nothing left of this large cavity 



but the track of the drainage tube- 
This case is an important illustration, 
it seems to me, of the safety of the pos- 
terior incision for tumors of consider- 
able size, where the line of incision is 
carried out, somewhat in the way here 
indicated. The saddest part of my re- 
port is to come: Four days ago this 
patient was taken with symptoms of 
cerebral trouble and suppression of 
urine, and she died with all the symp- 
toms of uraemia this afternoon at i 
o'clock, sixteen days after the opera- 
tion. As yet a satisfactory examina- 
tion has not been made to determine 
the condition of the opposite kidney, 
neither has there been a satisfactory 
microscopic examination of the tumor. 
Several sections have been submitted 
to examination, but none have shown 
bacillus tuberculosis. 

Post-mortem examination showed a 
highly congested and swollen organ in 
the remaining kidney; the capillary 
vessels were ruptured in many places. 



VAGINAL HYSTERECTOMY.— REPORT OF THREE CASES. 

BY J. H. ETHERIDGE, A. M., M. D. (rUSH), 
Gynecologist to the Presbyterian Hospital and to the Central Free Dispensary. 



The three cases reported herein 
were operated on at the Presbyterian 
Hospital. I can never convey an ade- 
quate idea of the relief to the operator 
offered by the method of haemostasis 
by forcible pressure on the broad liga- 
ments over that of Hgatures. I think 
no one can fully appreciate the untold 
superiority of the former method over 
the latter till he has had experience in 
the performance of that operation under 
both methods. 



Case I. — Mrs. S., aged 47, mother 
of nine children, always well, presented 
herself February i, 1887, with epithe- 
lioma of the cervix uteri. It did not 
involve the vault of the vagina. The 
broad ligaments did not seem to be 
thickened. Mobility of the uterus was 
complete. After preparatory treat- 
ment with a daily laxative and diuretic 
for a week, the operation was per- 
formed on February 8, 1887. 

The cervix was easily drawn down 



Vaginal Hysterectomy/. 



309 



to the vulvar orifice, and with scissors 
its vaginal attachment was divided. 
Strong adhesions to the bladder and 
rectum were found, and in consequence 
thereof, the rectum was opened in one 
place and the bladder in two places in 
the process of freeing the uterus from 
these two organs. After the two 
broad ligaments were sufficiently isola- 
ted and the fundus was turned back- 
wards and brought down, the left 
broad ligament was first penetrated 
and divided into two sections with 
heavy ligatures, and tied as securely as 
hands could tie them. It was then 
severed as closely to the corpus uteri 
as possible, and the whole organ came 
out of the vagina. Treating the right 
broad ligament similarly was a much 
easier matter, because the uterus was 
down and out of the way. This attach- 
ment was at once severed and the 
whole organ was then freed from the 
patient. The ovaries were then re- 
moved. The rent in the bowel was 
closed by continuous suture without 
difficulty. The longer rent in the 
bladder was then closed by continuous 
suture, but it was done at a great dis- 
advantage from its peculiar position, 
back of the symphisis and looking 
directly backwards. To draw down 
the bladder and to so evert the edges 
of the rent as to apply the stitches was 
a delicate and difficult task. The 
smaller rent, undiscovered at that time, 
was not closed. Just as this sewing 
up was completed there was observed 
welling up into the shapeless excava- 
tion left after the removal of the uterus 
great quantities of arterial blood. 
Which broad ligament it came from it 
was impossible to decide. After a 



long time the bleeding vessel, which 
was in the right broad ligament, was 
secured, but not till after a ligament 
was pushed off of the left broad liga- 
ment. All vessels were eventually 
secured, but not till a great quantity of 
blood had been lost. The top of the 
vagina was closed from before back- 
wards with continuous suture, the liga- 
tures were brought down, iodoform 
gauze stuffed into the vagina and the 
patient put to bed. 

Reaction followed reluctantly. She 
died from peritonitis and exhaustion in 
45 hours, having passed 8 ounces and 
I drachm of urine in the meantime. 
The autopsy revealed a small rent in 
the bladder, which was concluded to 
be the cause of the peritonitis. 

Case 2. — Mrs. C, aged 36, laun- 
dress; tall, spare, nervous, sanguine 
temperament, presented herself Febru- 
ary 10, 1887, with a small epithelioma 
in the cervix uteri. The upper por- 
tion of the vaginal cervix was not 
invaded. The choice between ampu- 
tation of the cervix and hysterectomy 
was left to the patient after full expla- 
nation of the dangers and results of the 
two procedures. She decided to have 
the latter operation, which was per- 
formed on February 25, 1887. 

The uterus was easily drawn down 
to the vulvar orifice and freed from its 
vaginal attachment with the scissors. 
The bladder was uncommonly closely 
attached to the uterus, and before its 
complete separation was accomplished 
it was opened. The opening into the 
Douglas cul-de-sac was easily effected 
and the fundus rocked backward 
through the sacral hollow, down and 
out through the vulva. The broad 



3IO 



Original' Communicatiom 



ligaments were secured with silk liga- 
tures and the uterus removed after its 
separation from them. The ovaries 
were l^separately removed immediately 
afterwards. In closing the vesical rent 
the left broad hgament shed its liga- 
tures and bled profusely, Hemorrhage 
was soon checked. The vagina was 
closed from before backwards, the liga- 
tures were brought down into the va- 
gina, and the latter organ was filled 
with iodoform gauze. 

The patient rallied well. The tem- 
perature rose to lOo'' on the second 
and third days. Thereafter nothing 
worthy of special mention occurred. 
On the tenth day an elastic ligature 
attached to the patient's left thigh was 
tied to those protruding from the va- 
gina, and in five days they began to 
come away, and in 48 hours the last 
one was removed. In 36 days she left 
the hospital. 

Case 3.— April 13, 1887. Mrs. C, 
ast. 49, widow; last confinement 28 
years ago; she is still menstruating 
regularly every three weeks, fliowing 
one week. 

Six months ago she began to have 
leucorrhoea and to lose occasional small 
amounts of blood. She has excellent 
general health. She is a good break- 
faster, digests well and is a good ex- 
creter from the bowels, kidneys and 
skin. She is well nourished, and pre- 
sents a promising outcome for any 
surgical ordeal. The only thing that 
one could wish different in her general 
aspect is a too rapidly acting heart. It 
beats over 90 times per minute, and 
the arterial impulse is persistent. She 
has often seen lateritious deposits in 
her renal secretion. 



Examination reveals an epithelioma- 
tous degeneration of the cervix, with 
about y^ inch of uninvaded tissue of 
the cervix between the cancer and the 
vaginal vault. The uterus was about 
4 inches deep, and it bled freely upon 
withdrawing the sound. The fundus 
was large and was easily felt through 
the abdominal wall. The uterus was 
freely movable, indicating the non-im- 
plication of the lymphatics in the broad 
ligament. The absence of the inva- 
sion of the vaginal wall and of the 
circumuterine tissues led to the recom- 
mendmg an operation for the removal 
of the entire uterus. 

From April 19 till May 5, the date 
of the operation, she took cascara daily, 
and digitahs and acetate of potash. 
The condition of the excretions seemed 
as nearly perfect as possible prepara- 
tory to an operation. The patient 
slept in the hospital the night before 
the operation, and took the customary 
general antiseptic bath and had ad- 
ministered several vaginal bichloride 
douches. 

Operation. — The cervix was drawn 
into the vulva with two large, lock vul- 
sella forceps, while the vaginal attach- 
ment to the cervix was divided with 
the scissors. Gradually and patiently 
the circumcervical tissues and the at- 
tachments of the bladder and rectum 
were crowded away with the finger- 
nail till the Douglas cul-de-sac could 
be opened. Then it was found quite 
impossible to reach the top of the fun- 
dus with the fingers. The cul-de-sac 
of peritoneum between the bladder and 
the uterus was then opened, with hope 
of being able to retroflex the uterus by 
means of the fingers placed before and 



Vaginal Hysterectomy. 



311 



behind the uterus. This manoeuvre 
was found hkewise to be an impossi- 
bility. After repeated vain attempts 
to reach the top of the fundus with the 
fingers, that method was abandoned. 
Trial of very deep suprapubic pressure 
to thrust the fundus back toward the 
sacral hollow, and at the same time of 
grasping and pulling down the fundus 
with a small culsellum forceps thrust 
through the Douglas cul-de-sac, at last 
succeeded, after three or four tearings 
out of the forceps, in getting the top of 
the uterus out into the world. 

Snap forceps were then placed on 
the broad ligaments and the latter di- 
vided. The subsequent dressing con- 
sisted in tucking a thin la3^er of idoform 
gauze into the vagina, care being taken 
to avoid separating the top of the vagi- 
nal walls. The danger of this separa- 
tion must be patent to any observer. 
Ribollet attributes the death of one of 
his patients to crowding too much 
gauze into the upper vagina. 

No stitches were used to close the 
upper end of the vagina. Its borders 
were permitted to collapse and to close 
in any position that they chanced to 
occupy. The fear that the bowels and 
bladder might seek an outlet through 
the vaginal tract is wholly groundless. 
One ligature was used for a vaginal 
artery. No attention was paid to it in 
the final dressing. The ovaries were 
both removed after the uterus was 
finally separated from its attachments. 

The patient reacted well from the 
shock of the operation, which con- 
sumed seventy-five minutes. Her daily 
progress was so uniformly satisfactory 
that any detailed descriptive statement 
of it would be monotony itself. The 



pulse ranged from 90 to 120 beats per 
minute; it was 98 when she left the 
hospital. The temperature reached 
loo'^ one morning only, and on five 
evenings, from third to the seventh 
days inclusive. 

The amount of urine passed daily 
during the first fourteen days after the 
operation is indicated by ounces in the 
following figures: 19, 19^^, 25, 23, 
26, 24, 23>^, 25, 30, 311^, 34, 40, 35 
and 263^. 

The forceps, one pair on each liga- 
mentum latum, were removed at the 
end of 48 hours. Although anyone 
knows that 48 hours of obliteration of 
the lumen of an artery must necessarily 
destroy its patency, yet the writer was 
filled with misgivings when the forceps 
were very carefully unwrapped and as 
carefully removed as gentleness ifself 
could supervise. The folds and creases 
of the vagina, as far up into the shape- 
less excavation as vision could peer, 
upon an exaggerated separation of the 
vulva with the fingers, were watched 
with an intensity of eagerness and 
anxiety, for their being inundated with 
the hot, scarlet blood that so easily 
comes from the ovarian and uterine 
arteries, that can be appreciated only 
by him who has experienced those 
emotions. No bleeding followed the 
removal of pressure from the uterine 
ligaments. The vagina was not again 
filled with gauze. Iodoform was blown 
into this cavern as far as was possible 
daily. 

It was impossible to state definitely 
the amount of dramage that escaped. 
Perhaps 3 tablespoonsful daily for the 
first two days would cover it; after- 
wards the amount could not have been 



312 



Original Communications. 



more than i tablespoonful on the third 
and fourth days each. After the fourth 
day none escaped to mention. 

Case ^ came to me several weeks 
ago for an incoercible hemorrhage. 
The patient, a woman 47 years of age, 
has borne eleven children, and has been 
having hemorrhage for eleven years. 
Everything in the way of medicine has 
been tried; the uterus has been curetted 
upon two different occasions, and she 
came to me supposing the ovaries must 
be taken out. I explained to her that 
I had had two cases of removal of the 
ovaries for hemorrhage, but that the 
operation had not cured the hemor- 
rhage. I also explained to her the 
danger of removal of the uterus, and 
she consented to the operation. The 
steps were simplicity itself, being a 
repetition of what I have given. The 
cervix was easily drawn down to the 
vulvar orifice and the cervical attach- 
ments freed at once as speedily as pos- 
sible. An incision was made in the 
cul-de-sac of Douglas, and I was able 
with a knife to divide the tissues with- 
out any trouble. I kept as close to the 
uterus as I could, and did not open the 
bladder. When the two broad liga- 
ments were all that supported the 
uterus, they were secured with long, 
snap forceps, and the broad ligament 
divided on the ricrht and left sides. 
Snap forceps were put on the neigh- 
boring deep vessels: that was all the 
haemostatic means that was resorted to 
from beginning to end. 

The patient was put to bed about 3 
o'clock, and about 6 I was telephoned 
that she was having a severe hemor- 
rhage. Concluding that it was one of 
the arterial branches from the vagina. 



I hoped that ergot would stop the 
hemorrhage. When I reached the 
hospital I found that after the use of 
the rectal injection of ergot the hem- 
orrhage ceased. The case ran along 
very well for 48 hours; afterwards the 
temperature was 99° for two or three 
days and then it ran up to loi*^. She 
was put upon the table and the wound 
exposed with a Sims speculum. Up 
in each angle or corner of the wound 
was a black, gangrenous looking mass 
about as big as my little finger, hang- 
ing down upon the vagina; which 
mass protruded from a little cavity 
there filled with the debris of the blood, 
which had probably been produced by 
the hemorrhage on the day of opera- 
tion. It had decomposed and was 
smelling very badl3^ That mass was 
pulled out. In the other side I was 
able to pass the forceps up a distance 
of about I ^ inch. I got out all the 
shreds and put the patient to bed. 
The temperature at once went down 
to 98.2 ^ , and since that time every- 
thing has progressed satisfactorily. 
This is the twenty-first day since the 
operation. I saw the patient this af- 
ternoon, and she calls for solid food 
and is to sit up to-morrow. The fol- 
lowing are some points of interest con- 
cerning this operation: 

/. Indication?! for its Performance. 
(a) — Ten years ago, and indeed until 
quite recently, the chief indication for 
the performonce of vaginal hysterecto- 
my was malignant disease. At present 
it is agreed by all operators that the 
earlier it is performed for cancer the 
greater are the chances for its non-re- 
currence. This dread malady always 
returns sooner or later after amputa- 



Vacrinal H\sierectom \. 



313 



tion of the uterine cervix, and of course 
proves fatal; whereas, when the whole 
organ is removed, the patient is given 
the only hope of a permanent recovery. 

H3'Sterectomy does not always pre- 
vent recurrence of the development of 
this neoplasm, vet it offers the best 
results. Martin reports 8 cases of hys- 
terectomy from cancer without relapse, 
varying from two and a half to live 
years. According to Sanger the av- 
erage of survival after this operation is 
eleven months. Olshausen reports 
cases after operation of relapse, once 
after eighteen months, twice after two 
years, and twice after three 3'ears. 

The most favorable conditions 
offered for hysterectomy are the non- 
involvement of the vagina, and com- 
plete mobility of the uterus, which 
shows the non-invasion of the ligamefi- 
ta-lata. In other words, the earlier in 
the disease the operation can be per- 
formed the better are the promises of 
a radical cure. Only too often does it 
occur that the disease has advanced 
too far before the gynecologist is con- 
sulted. 

(b) Procidentia uteri is another con- 
dition for which this operation is per- 
formed. Anaplastic operations do not 
always restore the organ to its normal 
level. Artificial vaginal stenosis to 
the extent of the non-admission of the 
little finger has failed ultimately to re- 
lieve the procidentia through gradual 
dilatation of the vaginal channel. 

(c) Fibrous Dodies of the uterus 
which offei the point of departure for 
serious irregularities have constituted 
a cause for vaginal hysterectomy. Of 
course reference is had to small tumors. 



Heydenreich reports four cases of op- 
eration with four successes. He^ con- 
siders that at present it is impossible 
to pronounce upon the relative merits 
of vaginal hysterectomy and of castra- 
tion for small fibrous bodies in the 
uterus. Pean^ recently reports a case 
of the same operation for multiple 
fibroids. 

(d) The hystero neuroses (inveter- 
ate dysmenorrhoea, neuralgia, convul- 
sions, etc.), for whicho ophorectomy is 
so often performed, Pean considers a 
justifiable cause for this surgical pro- 
cedure. His reasoning is, that these 
neuroses sustain an intimate relation to 
the uterus itself, consequently the uter- 
us should be included along with the 
tubes and ovaries. (Caldwell. Paris 
letter in Chicago Med. yournal and 
Examiner., February, 1887.) 

As an illustration of \hQ. furor opera- 
tions, a recent article from the pen of a 
Cologne surgeon, Dr. Frank, published 
in the April 3, 1887, number of the 
Archiv ftir Gynakologie, enumerates 
the following cases of removal of the 
entire uterus: For endometritis, four 
cases; for retroflexion or retroversion 
with fixation, three cases; pruritus 
itteriniis, once; and for neuralgia and 
retention of urine, one case. The 
members of the medical profession 
can scarcely read the account of these 
cases without being astounded at the 
amazing temerity of such proceedings. 

The various steps in the operation 
consist in, i. Freeing the cervix from 
its attachment; 2. Hcemostasis, and 3. 
The subsequent dressing. 

I. The cervix must be drawn down 
with forceps into the vulvar orifice if 



1 Albert Hej'dencich De Physterectomic vVaginale, i^emaine Med., Paris, i8S5, vi, 69, 70. 

2 Gazette des Hopitaui, October 12, 18&6, pp. 950, 951. 



314 



Original Communications. 



possible and the vaginal attachment 
severed with any cutting instrument, a 
bistoury, a blunt or a sharp-pointed 
scissors. Some operators prefer one 
instrument, others another. It is a 
trifling choice to make between them. 
The vulva should be held open later- 
ally by retractors deftly held just with- 
in the ostium; if they are thrust into 
the vagina too far they prevent the 
forced descent of the uterus. If they 
are wide enough a perineal retractor is 
unnecessary. Just before making the 
initial cutting it is well to push up the 
cervix (which has been drawn down) 
to its natural level and mark with the 
eye where the vagina is attached, and 
then draw down the organ and begin 
proceedings. This point is rather 
important because no one can tell 
where the vaginal wall terminates and 
the cervical covering begins, and one 
is invariably inclined to begin the eneu- 
cleation too far away from the cervix 
and thus to open the bladder. The 
encircling of the cervix can be made at 
once with tissues pushed away from 
the uterus in all directions till the 
broad ligaments are reached, when 
they will of course not be disturbed. 
The gravest necessity exists for keep- 
ing exceedingly close to the cervix an- 
teriorily, otherwise the operator will 
find that he has opened the bladder 
almost before he has any idea that he 
is dangerously near it. By keeping 
as closely to the cervix as possible an- 
other important, nay vital, advantage 
wiU be gained, viz. : the avoidance of 
wounding the ureter, which perforates 
the bladder just above the middle of the 
anterior vaginal wall. Wounding this 
duct complicates matters most wofully 



in that it necessitates the extirpation of 
the kidney. The surest way of determin- 
ing the dangerous proximity to the 
ureter is to discover the pulsation of 
its accompanying artery which is a 
branch of the uterine artery and is of 
considerable magnitude. Absolute 
safety from wounding this important 
channel is guaranteed to him only who 
keeps closely enough to the cervix in 
its denudation. Very soon the finger 
can be made to penetrate the perito- 
neal cavit}^, as will be indicated by its 
feeling the fundus covered with the 
smooth, glistening peritoneum. The 
freeing the posterior cervical wall 
should be prosecuted with the same 
care to remain close to the uterus and 
thus avoid opening the rectum. The 
finger easily penetrates the Douglas 
cul-de-sac, and the body of the uterus 
can then be explored readily. Up to 
this point, when the peritoneal cavity 
is opened the bleeding is considerable 
though not at all alarming. It is best 
to proceed as rapidly as possible and 
not to attempt to check hemorrhage. 
Occasionally the peritoneum is tough 
and cannot be perforated by the finger; 
then a blunt-pointed pair of scissors, 
closed^ can be thrust into this cavity, 
quickly opened and withdrawn, leaving 
an opening large enough to admit the 
finger. 

After opening the posterior cul-de- 
sac, some operators push a soft sponge 
into the peritoneal cavity, to remain 
there till the operation is terminated, 
for the purpose of preventing the en- 
trance of noxious matters and keeping 
the bowels up and away from possible 
injury. It also serves the purpose, 
upon its withdrawal, of drawing down 



Vaginal Hysterectomy. 



315 



the ragged edges of the peritoneum, so 
that in the wound peritoneum lies op- 
posed to peritoneum — a most desirable 
position to be secured. 

At this point two proceedings lie open : 
one is to bring the fundus down through 
the anterior cul-de-sac or through the 
posterior cul-de-sac — i. e., to actually 
and completely anteflex the uterus — 
and the other is, to let flexion entirely 
alone and to proceed at once with the 
treatment of the ligamenta lata with 
reference to preventing other vessels 
from bending, and dividing them, and 
thus freeing the uterus wholly from 
the body. Another plan resorted to 
before removing the organ has been, 
after securing the broad ligaments, to 
bisect the uterus from fundus to os, 
and removing each half separately. It 
must be a very exceptional case de- 
manding this proceeding. When the 
uterus is small, flexion is an easy mat- 
ter. When large, it is a very aifficult 
matter; and when very large, it is a 
feat impossible to accomplish. 

C. Staude^ recommends opening the 
Douglas cul-de-sac first, and retroflex- 
ing the uterus completely before open- 
ing the vesico-uterine cul-de-sac, in 
order not to permit the cancerous cer- 
vix to enter the peritoneal cavity as the 
fundus is brought downwards. The 
ante-uterine peritoneal space thus shut 
off will effectually prevent the cervix 
entering it. However, with the cervix 
firmly held by the vulsellum forceps it 
is impossible for it to ascend into the 
peritoneal cavity as the fundus is 
brought down. Furthermore, if the 
ante-uterine peritoneal space be not 
opened, the work of securing the lat- 



eral vesicular supply must be greatly 
embarrassed, and the danger of wound- 
ing the ureters greatly, almost mfin- 
itely, increased. 

The second step in the operation 
consists in hasmostasis, and it includes 
securing and dividing the broad liga- 
ments. 

The devices that have been used to 
secure hcemastasis are almost legion. 
Until very recently, silk ligatures only 
were used to secure the whole mass of 
the ligaments, or to secure it in sepa- 
rate divisions by the continuous or by 
the loop method. Later, the ecraseur, 
wire or the elastic ligature has been 
used. The cautery has been used. A 
separate cat-gut ligature for each tube 
has been recommended. Needles with 
a great variety of curves have been 
devised. The application of ligatures 
is attended with much difficulty, often 
failing in the most skilled hands. 

By far the best method of accom- 
plishing haemastasis is the snap for- 
ceps. It is a sure method; it abrevi- 
ates the operation and affords, addi- 
tionally, perfect drainage. Before 
using them it is always well to test the 
ratchet and ascertain whether they will 
hold permanently. Occasionally for- 
ceps will unsnap and a greater calam- 
ity cannot befall an operation than to 
have that occur after leaving the pa- 
tient. Tieing the forceps together 
when in doubt about their reliability 
can be done. 

After the peritoneal cavity before 
and behind the uterus has been opened 
and the uterus has been completely 
flexed, when possible, and is retained 
by the ligamenta lata only, the latter 



I Deutsclie Med. Wochenschrift. Berlin. 1886. xii. 602-604. 



3i6 



Original C onimunications. 



are ready to receive the forcipressure. 
With the forefinger of the left hand 
hooked over the superior margin of 
the left broad ligament, the right hand 
can adjust the forceps to compress the 
whole width of the ligament and tight- 
en the instrument to the last notch. It 
is best to attach it as near to the uterus 
as possible and yet permit room for 
dividing the ligament easily at its uter- 
ine end. While adjusting the forcfeps 
it is of course scarcely necessarv to 
mention the desirability of not inclu- 
ding in them a bit of omentum or a 
piece of intestine. I know of no 
greater satisfaction in gynecological 
operations that the operator can expe- 
rience than in tightening haemastic 
forceps on a broad ligament — a satis- 
faction greatly intensified when one 
has previously had the appalling acci- 
dent occur of the shedding of the silk 
Hgatures after the broad ligaments has 
been permitted to contract and with- 
draw into the pelvis up out of sight. 

When the uterus cannot be flexed, 
the forceps have to be applied in the 
best way that can be devised. With a 
much enlarged uterus, the forceps can 
be applied to include broad ligament to 
the extent of the w'idth of its jaws; 
that amount of ligament can be di\-ided, 
and up through the divided segment 
another pair of forceps can be pushed 
to include the remainder of the liga- 
ment, which in turn can be divided. 
If the finger cannot reach the superior 
margin of the ligament, the lower sec- 
tion of each ligament can be seized and 
divided, when it will be found that the 
whole organ can be made to descend; 
thus the entire ligament on each side 
can be divided. When this procedure 



is necessary, the difficulty of practicing 
flexion is greatly increased, because 
of the narrowing of the vaginal space. 

After removing the uterus, the parts 
should be allowed to retract, in order 
to allow any vessels to bleed that are 
prevented from it by their traction. 
By this means arterial twigs are often 
discovered which otherwise escape de- 
tection. All further arresting of hem- 
orrhages can be accomplished easily 
with forceps. This step in the opera- 
tion is of vast importance, since hem- 
orrhage can not only result fatally, but 
even when not large it can become the 
unsuspected cause of a fatal peritonitis. 

The last step of the operation con- 
cerns the management of the womb. 
The most elaborate sewing and drain- 
ing of the vaginal cavity have been 
resorted to. Stitching the peritoneum 
to the vaginal wall is regarded neces- 
sary by some operators. One operator 
recently stated, in his report of a case, 
that he stitched these two tissues to- 
gether in front of the uterus before 
opening the Douglas pouch. Stitching 
the anterior marginal border of the 
rent to the posterior border, drawing 
the ends of the legatures out through 
their centre, has been very commonly 
done. Running a purse-string suture 
around the top of the vagina, with a 
piece of rubber draining tube, and the 
ligatures passing through the middle 
of the puckering, has been used. 

Sewing up the vagina is wholly un- 
necessary in most cases. These various 
closings of the vagina have been re- 
garded as essential to keep back the 
bowels and to prevent septicaemia 
through the vagina. Of the former 
there is a minimum danger. When 



Suh-periosteal Resection of a Rib for ETn-pyenia in Children. 



317 



the operation is completed, the supe- 
rior vaginal opening then collapses as 
thoroughly and completely as the 
ostium vagina closes. The oozing, op- 
posed surfaces at once interdigitate and 
inaugurate the preliminary processes 
of union. They do not lie idle for 24 
or 48 hours before commencing union 
is set up. At the end of 48 hours the 
top of the vagina is all closed to the 
passage of fluids, excepting through 



that portion of it occupied by the 
means of drainage. 

The use of iodoform gauze in the 
vagina is of the utmost importance, and 
when wrongly used is a source of dan- 
ger. The vagina must be absolutely 
aseptic, and herein the gauze filled 
with iodoform becomes of such great 
service. Stuffing the vagina too full 
of this agent keeps apart the walls of 
the top of the vagina and prevents 
their union. 



SUBPERIOSTEAL RESECTION OF A RIB FOR EMPYEMA IN 
CHILDREN.— RECOVER Y.* 



BY ALBERT B. STRONG, 

I have within the past two years 
made subperiosteal resection of a seg- 
ment of a rib for empyema in two 
young persons, one a boy of 6 and the 
other a youth of 17 years of age. The 
results have been so satisfactory that I 
desire to place the cases on record at 
the present time, particularly so since 
able authority has recently condemned 
the operation in children. ^ 

Case I. — In May, 1886, I saw in 
consultation with Dr. Charles Venn, of 
this city, a boy 6 years of age. The 
father, mother and other children of 
the family were perfect pictures of 
health. The boy was large for his 
age, and up to his present illness had 
always enjoyed the best of health. 
Four weeks prior he began to cough, 
and eight or nine days later evidences 
of an effusion into the right pleural 
cavity were manifest. In spite of ap- 
propriate constitutional and local treat- 



M. D., OF CHICAGO, ILL. 

ment, the effusion increased, and when 
I saw him the chest cavity was com- 
pletely filled. The boy was much 
emaciated with continued fever and 
night sweats. 

A hypodermic needle thrust into the 
chest just above the eighth rib in the 
axillary line, revealed the presence of 
pus. Under ether the eighth rib was 
exposed through a parallel incision two 
inches in length. The periosteum, 
midway between the upper and lower 
border of the rib, was split in a longi- 
tudinal direction, the distance of an 
inch. By means of a blunt hook the 
periosteum and intercostal vessels were 
easily peeled off from the posterior 
surface of the rib, and three-fourths of 
an inch was cut away with bone nip- 
pers. This was done without wound- 
ing the intercostal vessels or pleura. 
Next the internal layer of the perioste- 
um was split to the same extent, and 



*Read before the Chicago Medical Society, October 17, 1887. 

2 See an article by Dr. Garnett, of Washington, on the "Surgical Treatment of Suppurative Pleuritis in Children, 
published in the Journal, Sept. 17, 1887. 



31^ 



Original Communications. 



parallel to the external layer. The 
pleura was opened when two quarts of 
laudable pus was evacuated. The 
chest cavity was immediately washed 
out with a warm saturated solution of 
boracic acid, and a large rubber drain- 
age tube retained in position. 

The subsequent history was une- 
ventful. He began to improve at 
once. The chest cavity was daily 
washed out with simple warm water. 
A wad of oakum was placed over the 
wound. The tube was kept in place 
six weeks, when the lung was entirely 
expanded and the wound healed com- 
pleteh'. Now, sixteen months after 
the operation, the boy is perfectly well. 
The right chest is normal like its fel- 
low in shape and function. There is 
but a small scar at the seat of opera- 
tion, and the rib has perfectly reformed 
in direction and shape. 

Case 2. — Norwegian boy, 17 years 
of age, always delicate, very thin and 
poorly nourished; six feet tall, pale and 
£enemic. Father, brother and one sis- 
ter died of consumption. Mother alive 
and doing well. Patient was first 
taken sick about March 10, 1887. The 
symptoms and signs indicated pleural 
pneumonia of the lower lobe of the 
right lung. In a few days he was 
convalescent. 

On March 24 he had a relapse, and 
the right chest slowly and intermit- 
tingly filled with effusion. He had 
night sweats, diarrhoea and cough, and 
a temperature of 102'-' to 104*^ F. On 
April 24, about five weeks from the 
commencement of the effusion, empye- 
ma being diagnosed by the h^-poder- 
mic syringe, with the assistance of Dr. 
Venn, I removed subperiosteal, one 



and one-half inches of the ninth rib in 
the axillary Hne. Four quarts of laud- 
able pus escaped. At the last about 
four ounces of clear serum passed out. 
Immediately washed out the chest cav- 
ity with a hot solution of boracic acid; 
introduced two large parallel rubber 
tubes with a drainage diameter of 
three-eighths of an inch each. These 
were held in position by a rubber 
shield and elastic bandage around the 
chest. The pleura was felt to be 
about three-fourths of an inch thick. 
During the next few days there were 
washed out large masses of lymph. 
Hot water injections of two quarts at 
a time were used, night and morning. 
A wad of oakum was kept over the 
opening and changed often. The diar- 
rhoea, sweating and cough began im- 
mediately to abate. The temperature 
in three days dropped to normal. On 
the first day of May, eight days after 
the operation, the tubes were crowded 
out. All the unfavorable symptoms 
had disappeared; he was eating and 
sleeping well. The opening on the in- 
side was closed, as I then thought by 
the expansion of the lungs; I subse- 
quently learned it was closed by the 
arching of the diaphragm. The tube 
was left out five days, when the tem- 
perature began to ascend, and soon 
reached 104. There was a return of 
the sweating, diarrhoea and cough. 
Nothing had escaped from the wound 
in the meantime. I then reopened the 
wound and washed out about five 
ounces of stinking pus and debris, 
passed a large Van Buren urethral 
sound into the chest, ^and ascertained 
that the lung was compressed into a 
small wad against the vertebral col- 



Subperiosteal Resection of a Rib for Empyema in Children. 



319 



umn. It had not expanded a particle. 
I felt the apex of the sound in the chest 
above the clavicle ; reintroduced longer, 
fenestrated drainage tubes, three inches 
in length. From this time on his con- 
valescence was uninterrupted. Tem- 
perature quickly became normal and 
did not again rise. He soon began to 
go out of doors and improved rapidly. 
On June 12, three weeks after the 
tubes reintroduced, my notes read: 
Boy has gained ten pounds, out of 
doors most all day. Eats enormously 
and digests well. No cough and but 
little discharge. The sound in the 
chest shows the lung has not expanded. 
Put in drainage tubes without fenestra, 
since granulations had crowded into 
the former tubes so as to nearly occlude 
them. Sent the boy to a farm near 
Whitewater, Wisconsin, with instruc- 
tions to keep tubes in position, and 
syringe out the cavity once a day with 
warm water that had been boiled. Ten 
weeks later, on August 25, he returned, 
looking altogether different. Was 20 
pounds heavier than when first taken 
sick, and expressed himself as never 
feeling better in his fife. The tubes had 
remained in until a few days before, 
when they had been crowded out and 
could not be reintroduced. Physical 
examination showed the lung expanded 
with good motion of the chest and 
vesicular murmur throughout. In a 
few days more the opening entirely 
healed and the boy left for Norway, 
perfectly recovered — six months from 
the commencement of his illlness and 
four months wearing the tube. 

It is only within a few years that 
surgeons have been bold enough to 
make a section of a rib for empyema. 



It is, perhaps, but natural that the op- 
eration should be condemned by those 
who have always used the trocar or 
incision. To oppose the operation on 
purely theoretical gronds and conclude 
that it is a grave and serious operation, 
is, I believe, contrary to the facts in 
the published cases. 

In the article alluded to in the com- 
mencement of the paper, we find a 
table by a London writer of thirty-four 
cases of empyema, treated surgically, 
occurring in children of from i to 10 
years of age. Of the number, seven- 
teen recovered after a short section of 
one rib had been made. The average 
time of recovery was seven weeks. 

Dr. Garnett reasons that had these 
cases been treated with the trocar and 
drainage tube, they would in all proba- 
bility have recovered equally as well. 
Here is what he says against exsec- 
tion: "When we consider the fact that 
the bony fabric of the chest is still in a 
condition of progressive development, 
the rapid and excessive deposit of cal- 
lus following the solution of continuity 
of a rib protruding into the cavity of 
the chest, irritating the lung, the inevi- 
table disparity and loss of symmetry in 
expansion of the two sides of the thorax, 
the growing condition of the child, 
which necessarily adapts itself to the 
physical results of the traumatic inter- 
ference, establishing often a permanent 
deformity,, associated at times with 
more or less spondylitis, and greatly 
restricted respiratory capacity of the 
chest, the pouch of periosteum from 
which the excised piece of rib has been 
dissected, the protracted healing and 
long-continued dressing of the open 
wound augmenting the chances of sep- 



320 



Society Transactions. 



ticasmia, and exhausting the vital ener- 
gies and recuperative resources of the 
Httle sufferer. We should hesitate be- 
fore resorting to so grave a surgical 
procedure when a more simple and 
conservative one can be safely and suc- 
cessfully practiced." 

Such conclusions, I think, should not 
go unchallenged. One does not find 
them from a careful study of these 
cases. The simple questions that I 
should like to invite 3^our discussion is: 
Is subperiosteal cutting away a short 
segment of one rib with modern surgi- 
cal treatment, liable to be followed by 
such grave consequences as the writer 
referred to would have us to beheve ? 



Free drainage in abscess cavities is the 
imperative rule at the present day. 
This is best obtained by making a 
patulous opening larger than is possible 
to make between the ribs. In my first 
case the rib has completely reformed. 
In the second it is growing again. In 
neither case did callus injure the lung. 
In both cases lung expansion and chest 
motion and shape are perfect. Septi- 
caemia, present in both cases, was 
quickly cut short by free irrigation, 
only possibly through a large opening. 
I would, therefore, conclude that in 
these two cases section of the rib at 
least added nothing to the gravity of 
either case. 



SOCIETY TRANSACTIONS. 
CHICAGO MEDICAL SOCIETY. 

STATED MEETING, NOV. 7, 1887. 



The President in the chair. 
Dr. James H. Etheridge read a pa- 
per on 

VAGINAL HYSTERECTOMY. 
(See page 308.) 
Dr. C. T. Parks: I am very much 
pleased with this paper, in that it in- 
troduces a method of controllig hem- 
orrhage that has been satisfactory to 
me a good many times. We are in- 
debted to Pean, of Paris, for this 
method. He depends upon it on all 
occasions and in all operations. It is 
not an unusal thing to find a wound 
that he has made containing a dozen 
of these forceps. He never uses a 
drainage tube. After seeing it done 
by him, I have resorted to the use of 
the forceps as a means of haemastasis 
in all operations where it was difficult 
to apply a ligature, and especially in 
removal of carcinoma of the rectum. 
Anyone who has performed that opera- 



tion knows how difficult it is to apply 
a ligature that can be trusted, high up 
in a wound so small as that made in 
the removal of a carcinoma of the rec- 
tum. And on several occasions I have 
left half a dozen forceps, removing 
them in twenty-four hours, without 
subsequent trouble. It saves a great 
deal of time, and is perfectly reliable. 
I do not think it is necessary, on all 
occasions, to leave the forceps on 48 
hours. I think that, after squeezing 
with the large-jawed forceps for 24 
hours, there is scarcely any danger of 
hemorrhage from a vessel the size of 
those that are included in it, and by 
diminishing the time of the retention 
of the forceps you reduce the danger 
of necrosis of the tissue contained in 
forceps. Another point: I don't see 
the necessity of turning the uterus 
over, thus endangering the entrance of 
diseased tissue into the peritoneal cav- 



Chicago Medical Society. 



;2i 



ity. The posterior wall is uncovered, 
the broad ligaments are exposed, and 
what is the use of turning the uterus 
over r These forceps will reach the 
top of it, and they will include the 
broad ligaments on either side, and 
they can be applied just as well with 
the uterus in position as if it was turned 
over. There is great necessit}- of 
keeping close to the uterus with the 
forceps. I think there is more danger 
with the use of the forceps, in including 
the ureter, than we are aware of; and 
if the operation is done where there is 
any probability of recovery, it does not 
do any harm to keep well up to the 
uterus. If the tissue is diseased be- 
yond that point, vou might as well let 
the patient alone. 

Dr. D. T. Nelson : I wish to quote 
a word from Martin, of Berlin, spoken 
before the International Congress, 
where this subject was discussed quite 
fully. He advocates the operation 
strongl}', and made this important 
point, which I think was not too much 
emphasized by the reader of the paper, 
that the operation is not justifiable 
when the uterus is not movable. When 
the tissues above and about the uterus 
have become involved by the diseased 
condition, then the operation should not 
be done. Martin's later operations 
have been only upon this class of cases, 
and consequently the promise of suc- 
cess — Dermanent cure — has been far 
greater than it would otherwise be. 

Dr. J. A. Robison read a brief pa- 
per on 

THE TREATMENT OF PERTUSSIS. 

He said that since the discovery of 
Poulet in 1S67 of a parasite which is 
probably the cause of whooping-cough, 
the disease has been treated by the 
local application of such germicidal 
agents as carbolic acid, eucalyptus, 
boracic acid, sulphur, illuminating gas 
and resorcin. These had been applied 
by inhalations, insufflations and sprays: 
but in many cases it is difficult to get 
children to allow the administration of 



the drugs; but he had used with suc- 
cess a solution of cocaine and resorcin 
in Semple's Atomizing Inhaler, the 
vapor being so fine that the drug is 
inhaled into the bronchial tubes with- 
out producing an}^ laryngeal spasm. 
This method of treatment had been 
successful not only in relieving the 
cough, but in cutting short the course 
of the disease. 

Dr. F. E. Waxham : Whooping- 
cough is a disease for which a great 
many specifics have been advocated, 
but I really believe that we possess 
none. Something over a year ago I 
remember reading of the fumes of sul- 
phur as being a specific; coming from 
a high authorit}^ I thought that we 
had at last found a remedy for this dis- 
ease, but upon giving it a faithful trial 
I found it entirely useless, the patients 
manifesting no relief w^hatever. And 
the same may be said of a great many 
other remedies that have been advo- 
cated as specifics. As it is generally 
conceded that the disease is produced 
by bacilli found in the mucus of the 
throat, the larynx and the trachea, and 
that the peculiar cough is reflex in 
character, it certainly follows that there 
are two indications to meet in the treat- 
ment of the disease: first, to destroy 
the bacilli as far as possible by means 
of germicides, as has been advised in 
the paper read; and second, to dimin- 
ish the reflex excitability of the nervous 
system by the use of sedatives and 
tonics. 

Dr. G. C. Paoli advocated the use of 
ergot in pertussis. In 15 cases it cut 
short the duration of the disease. 

Dr. Robinson, in closing the discus- 
sion, said : I was ver}- anxious to hear 
from the senior members of the pro- 
fession in regard to their belief in the 
pathology of the whooping-cough ; be- 
cause on that depends the treatment. 
I know it was formerly believed to be 
almost of a purely nervous origin, or 
at least of reflex origin, and was treated 
internally by quinine, belladonna, ergot 



322 



Society Transactions. 



and opium, and anti-spasmodics. Of 
late years it seems to me that it has 
almost been proven that the disease is 
of local origin, and it does not seem 
that we can fully deny the observations 
of Poulet and Berger, that they have 
found the bacillus of pertussis. I men- 
tion the treatment by germicides, be- 
cause all of these observers have no- 
ticed that the cough was lessened, the 
disease shortened and the patients 
obtained relief by local treatment, no 
internal medication being given. If 
that disease is a purely local one, due 
to bacilli, by the use of antiseptics we 
remove the cause of the disease and 
the accompanying nervous symptoms, 
and relieve the cough. I desire to 
ascertain the general belief of the pro- 
fession. Is the disease a purely reflex 
nervous one, or is it due to the para- 
sitic germs ? It is generally consid- 
ered a self-limited disease. The Japa- 
nese call it the one-hundred-days dis- 
ease, -and probably in three months it 
will wear itself out; but it seems to me 
that by the use of these remedies we 
can shorten it, and are thus doing a 
benefit to our patients. In regard to 
the insufflation of boracic acid in the 
nostrils, I think that is an argument in 
favor of this local treatment, for boracic 
acid is a potent antiseptic. Sprays 
have been used for a long time, but the 
difficulty is in spraying the larynx. 
The use of powders has been in vogue 
for a long time, but there is a difficulty 
in carrying out a treatment of insuffla- 
tion of powder by means of a powder- 
blower; although when blown through 
the nostrils there is a fine dust formed 
which is inhaled into the lungs. Bo- 
racic acid acts precisely as carbolic 
acid that is inhaled. 

The President, Dr. Chas. T. Parkes, 
reported 

A CASE 0¥ NEPHRECTOMY. 

(See page 305.) 
Dr. D. T. Nelson : I was very much 
pleased at the doctor's instructions in 
regard to preparing the patient for 



these serious operations, and I believe 
we have considerable to learn in that 
direction as yet. The method proposed 
I believe to be valuable in preventing 
shock. If it is not wandering in a field 
that does not apply to the paper, I 
would like to throw out another hint, 
which is, that we prepare the alimen- 
tary canal previous to these operations; 
if you choose, make it antiseptic or sep- 
tic by emptying it and subsequently 
giving antiseptic drugs, — preferably 
naphthalin in 5-grain doses three times 
a day. I would like to ask Dr. Parkes 
if, in making the incision, he was care- 
ful to preserve the capsule of the kid- 
ney and use that in facilitating his 
drainage ? I have had but one case of 
removal of a carcinomatous kidney. I 
removed that from the anterior region, 
not knowing what I was going after. 
I hoped I had a cyst of the liver of a 
hydatid form, but on reaching it I 
found it was the kidney. I opened the 
capsule of the kidney and preserved 
that, and after the kidney was enucle- 
ated, which was done much more easily 
than I supposed it would be, I had no 
difficulty in closing the vessels in the 
manner the doctor has described. After 
hgating the pedicle, it was dropped into 
the bottom of the capsule and the walls 
of the capsule fastened to the wound, 
and drainage tubes inserted so that 
there could be no communication with 
the peritoneal cavity proper. The re- 
sult of the operation was very satisfac- 
tory, and there was a rapid recovery, 
although signs of the recurrence of the 
disease are appearing in other tissues. 

Dr. D. W. Graham congratulated 
Dr. Parkes on his discovery of how 
best to reach the kidney and secure the 
pedicle. He was surprised, when he 
witnessed the operation, to see how 
accessible all the parts were. 

Dr. W. T. Belfield: The fatal issue 
of this case through uraemia empha- 
sizes^gain the necessity for ascertain- 
ing the integrity of the opposite kidney 
before removing the one under suspi- 



Chicaoro Medical Society. 



323 



cion. This precaution is especially 
needful in cases of renal tuberculosis, 
since the second kidney is so often the 
unexpected subject of this insidious dis- 
ease. In women the urine from the 
opposite kidney can be isolated by 
catheterizing its ureter through the 
urethra, or, if that fails, through a 
small incision through the vesico-vagi- 
nal septum, whereby the orifices of the 
ureters are rendered accessible. If the 
urine be thus obtained previous to the 
operation, and be found normal in 
quantity and quality, the surgeon can 
be reasonably confident that nephrec- 
tomy will involve no danger of uraemia 
at least; while, if this precaution be 
neglected, the greatest care and skill 
may be vitiated by uraemia through 
unsuspected disease of the remaining 
kidney. 

It is questionable whether for neprec- 
tomy, or, indeed, all operations upon 
the kidney, chloroform is not preferable 
as an aneesthetic to ether. The decided 
renal irritation caused by the latter may 
possibly be a considerable factor in pro- 
voking ursemia in such cases, where 
the second kidney is suddenly taxed 
with an extra burden. 

Dr. Parkes, in closing the discussion, 
said: The old incision recommended 
for exposure of the kidney, is an incis- 
ion made parallel with the last rib, one- 
half or three-fourths of an inch away, 
a safe distance away, to enable the sur- 
geon to avoid entering the pleural 
cavity. With this incision the surgeon 
has always had a good deal of difficulty 
in exposing and uncovering the kidney 
and getting at the blood-vessels. One 
operator relates that he proceeded all 
right until he divided the upper half of 
the pedicle, then the patient bled to 
death. You can see that the incision 
here recommended exposes everything 
to view. If you will experiment on a 



dead body, with a healthy kidney, — 
trying first the old incision and then 
this one, — you will be convinced of the 
latter's worth. I am convinced of an- 
other thing, that it is a good plan, in all 
cases of pus degeneration of the kidney, 
to open the cavities one after the other, 
if necessary, for the purpose of dimin- 
ishing the size of the tumor, and also 
for the purpose of diminishing the con- 
gestion around the kidney. The great 
amount of hemorrhage that occurs in 
this operation is from the enucleation 
of the kidney, and with a small incision 
it is very difficult to control the bleed- 
ing points. I think a great point is 
gained in every operation by having 
the work under your fingers. 

In reference to Dr. Nelson's question 
as to whether I cut down on the cap- 
sule, I am not positive whether I did or 
not. I pursued the course which I fol- 
low in removing all tumors — to cut 
down on the tumor and to get as close 
to it and as far away from the danger- 
ous points as possible. I kept close to 
the surface of the kidney and awav 
from the peritoneum. 

I do not know what would have 
been gained by Dr. Belfield's sugges- 
tion. This patient wa-s secreting urine 
from the other kidney into the bladder; 
it was emptied out through the ureter, 
and could be collected and examined 
just as well as if the ureter had been 
catherized. In the first 24 hours the 
patient passed 7 ounces of urine from 
the bladder; in the next 24 hours, 10 
ounces, and so on up the time of the 
occurrence of the unfortunate symp- 
toms to which I have referred. The 
largest amount passed was 17.3 ounces 
in 24 hours. Up to that time there 
was nothing in the appearance of the 
patient that would make one think she 
was not going to recover. All at once 
the chancre and the end came. 



It has been ascertained that the life age beard grows 6^ inches in one 
of an eyelash is 90 days, that the aver- year. 



324 



Selected Articles. 



SELECTED ARTICLES. 
ON THE TREATMENT OF FCETID CORYZA. 

BY SOLOMOIN SOLIS-COHEN, A. M., M. D., PHILADELPHIA, PA. 



The obstinate " nasal catarrh," at- 
tended with excessive production of 
thick, discolored and offensive mucoid 
material, the discharge of which into 
the pharynx forms one of the most dis- 
tressing symptoms, is a troublesome 
condition to treat; yet one which yields 
in greater measure than is commonly 
supposed, to active, intelHgent, persist- 
ent, mild treatment. 

I prefer the name proposed by J. 
Solis-Cohen — foetid coryza — to the 
more recent term, " atrophic rhinitis," 
because the latter designation is not 
always applicable. I have seen quite 
a number of cases in which there was 
little or no atrophy of the turbinated 
tissues; although it is undoubtedly true 
that in the majority of cases there is 
considerable atrophy of these structures 
— often, indeed, the entire lower turbi- 
nated body, bone and all, will have dis- 
appeared almost without trace. The 
name ozaena, frequently applied to this 
affection, is sometimes made so gen- 
eral, and sometimes so restricted, that 
I prefer to discard it altogether. 

The remarks concerning treatment, 
that follow, are not concerned with 
those forms of foetid coryza which de- 
pend upon ulcerative processes, or the 
presence of calculi or other foreign 
bodies; in v.hich cases removal of dead 
bone, or foreign body, is of course in- 
dicated, and the particular measures to 
be instituted will depend upon the ex- 
tent and situation of disease. When 
there is but slight ulceration, or begin- 
ning locaHzed necrosis, scraping of the 
tissues, followed by cleansing and dis- 
infectant measures, may alone be re- 
quired. 

In those cases where the nasal struc- 
tures are as yet intact, or where there 
is simple atrophic change, the treat- 
ment, as a rule, is very simple; but it 
needs to be persisted in. 



The first principle is cleanliness. No 
matter what the origin of the masses 
which are discharged, or which more 
often remain pent up in the nasal cham- 
bers, giving rise to offensive odors, 
their presence is an additional source 
of irritation, tending to prolong dis- 
eased conditions; and they must be 
gotten rid of. 

Simply spraying the nose by means 
of an ordinary hand-ball atomizer will 
not answer. The nasal douche is apt 
to be abused, or used improperly, if 
entrusted to patients. The patient 
should be given an itomizer throwing 
a coarse spray, and directed to use 
some simple detergent solution, such as 
borax, soap-bark and tar-water, or 
even ordinary table salt in water 
(warm) thrice daily, in order to do 
what he can towards keeping the parts 
clean ; but at first, frequent visits to the 
physician's office will be necessary in 
addition, for the performance of ma- 
nipulations which the patient cannot 
exercise upon himself. 

The passages should be first sprayed 
thoroughly with a coarse spray of a 
warm solution of hydrogen dioxide in 
distilled water (one part of a 15- vol- 
ume solution to one or two parts of 
water), and then syringed with warm 
water, say 100*^ F., alkahnized with 
borax or baking soda, to which also a 
small quantity of the liquor carbonis 
detergxns may be added. The syring- 
ing must be carefully and gently done, 
first through one nasal passage, then 
through the other, anteriorly and pos- 
teriorly; the latter procedure being ac- 
complished by means of a curved nozzle 
reaching up behind the palate. With 
a little practice these manoeuvres may 
be executed without discomfort to the 
patient. The masses loosened by 
spraying and syringing must be ex- 
pelled by the patient's efforts, and the 



On the Tj'eatment of Foetid Coryza, 



325 



measures must be continued, supple- 
mented, if need be, by gentle swabbing 
with a cotton wad, until the nasal pas- 
sages and pharynx are absolutely clean. 
The fact of cleanliness should be ascer- 
tained by rhinoscopic inspection. If 
the patient makes daily visits for the 
first two weeks, in an ordinary case, at 
the end of that time it will be found 
that it is both easier to cleanse the pas- 
sages and that the amount of material 
to be removed has considerably les- 
sened. The patient will also report 
that he has had less difficulty in main- 
taining the cleanliness secured, by his 
own little performance with the hand- 
ball atomizer. According to the pro- 
gress of the case, the patient may soon 
be instructed to call every other day, 
and his own home procedures be aug- 
mented by direction to snuff up from the 
hand, morning and evening, warmed 
milk, containing a pinch of table salt. 
And as the improvement continues, the 
intervals between the active measures 
of the physician are gradually length- 
ened; until, in an ordinary case, at the 
end of six months the patient is able to 
keep himself comfortable by the use of 
the atomizer night and morning. 

This persistent cleansing is the essen- 
tial feature of the treatment. In addi- 
tion, the individual conditions of differ- 
ent cases suggest a variety of measures. 
After cleansing, it is advantageous, in 
cases showing signs of sluggish inflam- 
mation, to apply to the nasal mucous 
membrane a solution of iodine and car- 
bolic acid in glycerine (one grain each 
to the ounce) by means of a brush or 
cotton-wad. Very often the insuffla- 
tion of some disinfectant powder, such 
as iodoform or boric acid, or a mixture 
of the two, will materially assist pro- 
gress. 

When, notwithstanding the accumu- 
lation of foetid mucoid or muco-purulent 
masses, there is reason to believe that 
the normal moisture of the nasal pas- 
sages is deficient, the inhalation of the 
recent vapors of ammonium chloride is 



quite useful in stimulating the mucous 
membrane to healthy activity. Inhala- 
tion through the nose, with exhalation 
through the mouth, is preferable to the 
ordinary method of inhalation through 
the mouth with exhalation through the 
nose. The apparatus required is very 
simple and may be constructed for ones 
self with a hand-ball and a few bottles 
and glass tubes. It is important to 
wash fhe vapor thorougly to remove 
any excess of either hydrochloric acid 
or ammonia. 

This measure is particularly service- 
able in cases in which the discharge 
consists almost wholly of dissected 
masses of epithelium desquamated in 
an immature condition. The inhala- 
tion of ox\^gen is often beneficial. Thy- 
mol, eucalyptol and other balsamic and 
antiseptic vapors may also be inhaled. 
A weak solution of thymol in alcohol 
may be shaken up with warm liquid 
cosmoline and the nasal passages 
sprayed therewith. 

Internal treatment is sometimes indi- 
cated. In strumous children, arsenical 
preparations may be given, of which I 
prefer Donovan's solution. Iodide of 
iron and cod-liver oil are sometimes 
useful. Potassium iodide may some- 
times be given, to cleanse the passages 
by the flux of an artificial serous coryza, 
sometimes with quite happy effect. I 
usually resort to this measure at inter- 
vals during the course of treatment. 
Cubeb may be administered in the 
form of the oleo-resin dropped on su- 
gar, or in pill of the recent powder, to 
gently stimulate secretion during its 
elimination by way of the nasal mucous 
membrane. Ten to fifteen drops of the 
oleo-resin of cubeb three times daily, 
after meals, is the ordinary dose for an 
adult. 

Diet should be regulated. It is im- 
portant to forbid patients, especially 
children and young women, to eat 
candy, pastry and sweets. The prohi- 
bition must be absolute. Starchy foods 
should be reduced to a minimum. The 



326 



Selected Articles. 



functions of the digestive and excretory 
organs, including the skin, must be 
carefully watched and maintained at a 
proper standard. Exercise in the open 
air and hygiene in general must not be 
neglected. 

By carefull}^ maintaining general nu- 
trition and vigorous function, with the 
topical measures already described to 
secure and maintain cleanliness, and 
such constitutional medication on the 
lines indicated, as the individual case 
may require, the case of catarrh that 
cannot be greatly ameliorated must be 
exceedingly rare; and what is practi- 
call}' a cure may be obtained in the 
majority of cases. As a matter of 
course, the longer the disease has ex- 
isted the longer it will be necessary to ^ 
continue treatment. A month for a 
year, and three months in any case is a 
fair rule. 



It may be necessary for the patient 
to continue cleansing the parts by 
means of his atomizer as a part of his 
regular morning toilet; but that surely 
is a very little matter in comparison 
with the discomfort and annoyance 
which the possession of a foetid coryza 
entails upon the patient and those with 
whom he comes in contact. 

I have deferred until now the men- 
tion of the cutting, burning and boring 
methods, happily becoming less preva- 
lent in the management of all forms of 
nasal disease, in order to mention my 
conviction that they have often con- 
verted a simple case of catarrh, amen- 
able to the mildest measures, into very 
obstinate cases of the affection now 
under consideration — Med. and Surg. 
Ref. 



EPIDIDYMITIS AND ORCHITIS. 

BY J. B. JOHNSON, M. D., WASHINGTON, D. C. 



Epididymitis and orchitis are most 
commonly presented as complications 
of gonorrhoea, and rarely show them- 
selves before the beginning of the sec- 
ond month of a gonorrhoeal discharge. 
As long as the gonorrhoeal inflamma- 
tion is confined to the anterior portion 
of the urethra, epididymitis and orchi- 
tis are exceedingly rare as complica- 
tionr of gonorrhoea; but when a gon- 
orrhoea runs into the second month, 
the inflammation is apt to gradually 
extend to the deeper part of the 
urethra, and from thence, through the 
vas deferens, to the epididymitis. This 
result is produced in about ten per 
cent, of the cases of gonorrhoea. 
Sometimes the inflammation confines 
itself to the epididymis, and extends no 
farther; but this is of rare occurrence. 
The rule is, for the inflammation to 
extend from the epididymis to the tu- 
nica yaginalis, and to the body or sub- 



stance of the testical itself, thereby 
causing acute orchitis. The left testi- 
cle is more frequently attacked than 
the right: but now and then both tes- 
ticles will take on inflammation at the 
same time, producing double orchitis. 
When the epididymis and testicle are 
equally involved in inflammation, it is 
a difficult matter to distinguish them 
by the touch: and it is only when the 
inflammation is not severe, and is not 
accompanied by an effusion into the 
tunica vaginalis that it can be ascer- 
tained by manipulation that the epidid- 
ymis is alone concerned in the inflam- 
mation. The S3-mptoms are of an 
active and decided character; and like 
those of other local inflammations of a 
pronounced nature, are too indicative 
to require an enumeration; and a little 
inquiry in reference to concomitant 
symptoms soon invites an easy diag- 
nosis. 



E'pididvmitis and Orchitis. 



327 



The Treatment, — The relief which 
rest gives to the inflamed epididymis 
and swelled testicle indicates that the 
recumbent posture must be constantly 
maintained in the treatment of inflam- 
mation of these organs; and the ease 
which the lifting the weight of the 
enlarged and swollen testicle off the 
tender spermatic cord affords, likewise 
points out the necessity of keeping the 
bottom of the scrotum on a level with 
the top of the thighs, while the recum- 
bent position is steadih' maintained. 
This can be easily accomplished b}* 
bringing the testicles to a comfortable 
height bv suitable packing between 
the thighs. A cloth, frequently wetted 
with the following lotion, should be 
constantly applied to the scrotum : 

R. vinegar, 

Water, aa 7 ounces; 

Tinct. of arnica. 2 '4 ounces; 

Powd, muriate of ammonia, 6 drams. 
Mix. Sig. — Shake well, and keep constantly 
applied to the swelled testicle. 

Having enjoined the recumbent po- 
sition, and placed the testicle in the 
right position, the next duty is to 
adopt such internal or constitutional 
treatment as will be most likely to 
relieve the epididymis and testicle of 
their abnormal condition. My plan of 
treatment has been very satisfactory 
to me, and has alwavs afforded me 
speedy and prompt success. The 
stomach will be found sick, the tongue 
coated, the skin hot, the pulse quick, 
and the bowels constipated. I usually 
order 5 grs. of calomel and 10 grs. of 
blue mass, made into three pills at one 



dose; and in three hours after the pills 
have been taken, I have administered 
a half ounce of sulphate of magnesia, 
and this dose of salts I direct to be 
taken once a day afterwards, in order 
to keep the bowels in a soluble condi- 
tion. It is a well-known therapeutical 
fact that iodine and its preparations 
exert a positive effect upon the gland- 
ular organs of the body; and in order 
to avail mvself of this physiological 
action of the iodine preparations, I use 
the following internally : 

R. Iodide of potassium. 

Bromide of potassium, aa i dram; 

Fl'd ext. of aconite root, 3 drops; 

Camphor water, 6 ounces. 

Mix. Sig. — Shake well; dose, a tablespoon- 
ful every hour. 

This dose I have continued every 
hour until the inflammation begins to 
diminish, and then the interval is made 
every two or three hours, and the 
medicine continues at these intervals 
until the swelhng and induration of the 
testicle have entirely disappeared. At 
the end of from two to four days the 
orchitis is so much relieved that a sus- 
pensory bandage can be worn, and a 
cautious return to locomotion permit- 
ted. Under this treatment the gonor- 
rhoea is ver}- much benefitted, and by 
the addition of two copaiba capsules, 
three times a day, the discharge from 
the urethra rapidly disappears. If the 
iodide of potash mixture and the co- 
pabia capsules are continued for twelve 
days after the gonorrhoeal discharge 
has ceased, a cure will be very surely 
made. — Med. and Surg: Reporter. 



DIPHTHERIA IN PRIVATE PRACTICE. 

BY A. FUHRMAN, M. D., ST. LOUIS. 



Before entering on the much talked 
of subject of diphtheria, I should like 
to make a few preliminary remarks, 
and while they may not properly be- 
long to the subject at issue, they bear 
some relation to certain points which I 



raise and may make them pertinent to 
the whole. The old saying, " Man, 
know thyself," stands out brilliantly 
before us all, and yet but how little 
attention do we pay to it. Man is but 
a delicate piece of mechanism, the 



328 



Selected Articles. 



workings of which " be it the act of 
self-preservation or the mechanical 
part, as viewed by the world at large," 
is controlled exclusively by the laws 
ordained by its Creator. That in the 
course of natural life there is wear and 
tear, that impaired function will mani- 
fest itself, that what at times seems 
very insignificant may assume propor- 
tions to endanger the very existence of 
the whole; that this may be due to 
either a natural or acquired cause, are 
facts. 

As with any mechanical contrivance, 
be it ever so simple, let there be a 
proper want of attention, and what will 
be the result? Nature banks her fires, 
and makes the necessary attempt, by 
sleep, to accomplish repairs on the one 
side, and on the other we elect some 
one from our midst to specially study 
this our human piece of mechanism, to 
guard and assist nature to rectify when 
necessary. Often we extend a helping 
hand and it is treated with disdain; and 
while we know that we have tried ever 
so hard, we have never reached that 
stage where we can correct all imper- 
fections, yet we must not lose courage. 

In speaking of diptheria, I cannot 
concur in the prevalent idea that it is so 
fatal a disease, in comparison with 
others affecting the mortal frame. It 
is true that there is a certain amount of 
danger connected with it, but we have 
similar dangers to contend with in other 
diseases, and from experience I would 
say that the dangers entailed by this 
disease are not near as great as repre- 
sented. The science in the treatment 
of diptheria has been so far advanced 
that it is a comparatively easy matter 
to take the aggressive and combat the 
faulty wayji of nature, and correct and 
stimulate the same. 

The question often is asked, if not 
by one of the family in which you ha\-e 
a patient, by oneself, will the patient 
recover ? I would say, don't let that 
take a moment of your time. You are 
the commander and you have your 



forces to work with; and while it is 
only too true that victory is not always 
ours, yet it is a wise plan to marshal 
our forces very carefully and effectively, 
and consider the result after your labor 
is done. The doctor must not lose 
courage or patience, nor cease his 
watch that every instruction may be 
carried out fully. He cannot see his 
patient too often, that he may note 
every change and be ready to meet it. 
At times he will find the result very 
gratifying, and at other times discour- 
aging, and here is the time to show 
true courage. 

Diptheria manifests itself in various 
w^ays, and while some patients appear 
languid and depressed, others appear 
full of lite and vigor throughout its 
whole course, and yet all other symp- 
toms, such as high temperature, pearl 
grey appearance of the tongue, anxious 
look of the eye, will be alwa3^s present, 
while the exudation or membrane may 
or may not be within sight. 

The treatment that I propose to offer 
received its initiatory from my friend, 
Dr. Wm. Porter, of St. Louis, and I 
am under obligations to him for the 
success I have had. I cannot resist the 
temptation to make an attempt to force 
upcn the profession, if I may so term 
it, the full intent and meaning of his 
ideas, as published in various papers, 
and especially his last, read before the 
American Laryngological Association, 
at its ninth annual congress, and re- 
ported in the Nczv York Med. Joiir.., 
Nov. 19, 1887. 

The statements I make are based 
upon 119 cases, with the following 

COMPLICATIONS. 

Three cases of blood poisoning. 

Two cases of blood poisoning, fol- 
lowed by paralysis of the soft palate; 
age three to six years. 

One case of blood poisoning; age 20; 
complete paralysis of lower and upper 
extremities. 

Five cases of diptheritic croup. 



Di-phtheria in Private Practice. 



329 



First died. 

Second died from a second attack. 

Third had three different attacks; 
recovered. 

Fourth, two attacks; recovered. 

Fifth, one attack; recovered. 

Two cases of recurrent diptheria. 

Two cases of scarlet tever compHca- 
tions; both finally died of acute nephri- 
tis. 

Two cases measles of appearing on 
the third day; recovered. 

One case where no action could be 
gotten from the bowels for a period of 
five days, by medicines or injections. 

When I am called upon to see a pa- 
tient, be it in the office or elsewhere, 
my first impulse, after noting the pulse, 
is to examine the tongue, the appear- 
ance of which is often very character- 
istic, so much so in my experience as 
to be a rule, with only one exception, 
i. €., where a mercurial had been taken, 
then it loses its characteristic appear- 
ance. If the peculiar tongue presents 
itself, and the body is hot, I proceed to 
examine the condition of the mouth, 
larynx, etc. Sometimes fever is seem- 
ingly to the sense of touch absent, and 
then if the thermometer is brought into 
use, a fever will be discovered. An 
examination may disclose a high state 
of inflammation and often an exudation. 
I have found the throat cone-shaped, 
— the base, the roof of the mouth and 
the apex below the mucous membrane 
appearing red, streaked, very tense and 
glossy. 

Whenever these symptoms present 
themselves, though there be no exuda- 
tion in sight, the doctor must assume 
the aggressive, and let the patient have 
the benefit of the doubt. He must be 
prompt and decisive in his action, in 
order to check the disease in its infancy. 
He must assist nature to hold her own 
until she can loosen the fangs of that 
deadly anodyne that has enwrapped the 
patient, and eliminate it through the 
proper channels. 



My course of treatment is both local 
and constitutional, internal medication 
being invariably the rule, while restric- 
tion of local applications applies first to 
cases where the vitality of the patient 
is very great, and anruliness is very 
marked; and again, to cases where the 
application becomes painful, or hinders 
deglutition and thus indirectly invites 
starvation. The patient is often cos- 
tive, and I administer a moderate dose 
of calomel, and find that children will 
need more in proportion than adults. 
As an external application for enlarged 
glands, I use equal parts of ungt. hydrg. 
and ungt. bellad. morning and evening. 
One hour after I have given the calo- 
mel, I begin with iron and stimulants 
internally, and quinine if needed, giving 
small doses frequently. 

The quinine may produce not only a 
tonic but anodyne effect, the patient 
sleeping soundly for hours. ( See article 
of Dr. Eklund, of Stockholm, Thera- 
peutic Gazette^ Dec. 15, 1887.) From 
the first I use a local application of tr. 
fer. chlor. and glycer., equal parts, 
every two hours, only discarding it in 
cases where it proves painful, and then 
I use an antiseptic gargle frequently. 
A Httle patience and precaution is neces- 
sary in making the application. We 
must gain the confidence, and then our 
work is very easy — immediate relief 
after every application as a rule. The 
application is made by means of absorb- 
ent cotton fastened to a holder; it is 
softer than a sponge probang, and each 
piece of cotton being destroyed after 
an application, makes it more cleanly 
than if a probang or brush be used, and 
consequently more effective. 

I stimulate the patient, and give 
liquid foods — beef tea — and keep the 
bowels open with calomel or oil, and 
less calomel will be necessary as the 
case progresses. 

In closing my article, I want to bring- 
out one particular question — /. ^., the 
marked derangement of the digestive 



OC)*^ 



Selected Ai'ticles. 



and secretive organs in this disease; we 
find this derangement more or less 
marked. We find, also, that just as 
soon as we rectify this trouble, so much 
faster will the trouble in the throat 



abate. I would insist that nature might 
be assisted, from time to time, to elim- 
inate superfluous secretions and make 
it a benefit to the whole. — Weekly Med. 
Rev. 



A SUBSTITUTE FOR THE ORTHODOX PESSARY. 

BY W. GILL WYLIE, M. D., NEW YORK. 



Having no paper to read, I will sub- 
stitute a few remarks upon a subject 
that I have often wished to bring be- 
fore the society, as it has been of much 
practical benefit to me, viz. : the abuse 
of the pessary. I am entirelv satisfied 
that in the text-books too much stress 
is laid upon the matter of displace- 
ments as being the ci'use of uterine 
disease. I mean that I think it is a 
mistake to regard simple displacement 
of the utt^rus as a disease. It is very 
frequently associated with serious dis- 
ease, but, as a rule, if the disease is 
cured, the displacements are of little 
consequence. 

I never did adopt the use of the 
stem pessary, having felt satisfied that 
it is of little practical value, and that it 
is risky. 

I recognize the fact that retroversion 
is often a serious complication, espec- 
ially when the uterus is large or when 
the parts are very much relaxed; or 
when the uterus prevents the free 
egress of the fecal matter. But it is 
not a disease. 

It seems to me that there will be a 
radical change in the teaching of the 
text books upon this subject. The 
thing has been entirely overdone. 

Lonfj acjo I was convinced that the 
pessary was only a helping instrument; 
that if it relieved the patient, it simply 
relieved her, and that its use alone was 
not good practice. Some years ago 
Dr. Sims introduced glycerine as an 
agent to be used in the vagina, with 
the view to producing a watery dis- 



charge. He also found that if it was 
left there for forty-eight hours it would 
very frequently undergo some kind of 
ferment or change resulting in a vag- 
initis, and do more harm than good. 
He also mixed with it alum, and found 
that alum increased the tendency to 
the watery discharge. 

x\ number of years ago I took up 
the subject, but accomplished little 
until boro-glyceride was brought out. 

A standard formula that I use with 
great success in my practice is boro- 
gl3-ceride and enough pure glycerine 
to make a pint, and one ounce of sul- 
phate of alum (if I want an astringent; 
if not, the acetate of aluminum). 

Then I found if I took cotton in a 
soft, fluffy bunch, tied it with a string, 
saturated it with the solution, and put 
it up against the uterus, that, often in 
six hours, that piece of cotton would 
be rolled into a ball which would rest 
against the urethra and set up an irri- 
tation. I saw then that this would not 
do, and it occurred to me to take the 
cotton and roll it up over a rubber 
tube: after it had been rolled to the 
size desired, I tied the end of it firmly 
with a string. That answered very 
well. Later I secured some borated 
cotton of Eimer & Amend, which 
comes in flat sheets. I found that by * 
rolling this firmly into a roll about one 
inch in diameter and two inches long, 
and tying it with a good flax string at 
the end, that I had cotton in such 
shape that, if it was thoroughly satu- 
rated and put into the vagina^ it would j 



A Substitute for the Ortliodox Pessary. 



331 



retain the shape for four da^-s. It 
would stay where it was put, and in 
four days it would be almost in the 
identical position. I also found that, 
for the first twenty-four hours after its 
introduction, there would come awa}' a 
profuse watery discharge, from four 
to eight or nine ounces, in proportion 
to the congestion of the uterine vessels. 

The method of introduction is as fol- 
lows : Place the patient in Sims' posi- 
tion, then introduce Sims' speculum; 
after saturating the cotton thoroughly, 
pull back the perineum and push the 
cotton against the cervix, letting the 
cervix rest on the anterior part of the 
cotton. Hold the cotton in that posi- 
tion and remove the speculum. The 
adterior portion would then lie in the 
direction of the pubic bone. 

It acts as a pessary, except with 
more certainty, because the perenium, 
springing up against the cotton, keeps 
it in place. 

The action of the boro-glyceride is 
to prevent any kind of ferment or 
change. It has a good effect in ca- 
tarrhal conditions, and it does not in- 
terfere at all with the action of the 
glyceride and alum in producing the 
watery discharge. I am satisfied with 
this as a means of keeping the uterus 
in place, and at the same time as tend- 
ing to cure any uterine congestion. I 
leave it in the patient for twenty- four 
to seventv-two hours; then wash out 
the coagulated mixture, and on the 
third or fourth day make a second ap- 



plication. It there is much of a drag- 
ging sensation, I tell the patient to 
wear it two or three days. 

The manner in which this acts as a 
curative agent, it seems to me, is per- 
fectly plain. The watery discharge 
which comes from the glands of the 
mucous membrane, not only of the 
vagina, but of the uterus itself, forces a 
rapid circulation through the pelvic 
vessels; it acts in the manner of a very 
hot poultice, by getting up an active 
circulation through the pelvic tissues; 
and in that way it helps to eliminate 
disease. 

You can theorize about this as much 
as 3^ou please, but practicall}' it is a 
very great success. 

I can take a case of subinvolution of 
two or three months' standing, with 
the dragging sensation and more or 
less leucorrhoeal discharge, and in from 
three to six weeks I will reduce the 
uterus to its normal size, using nothino- 
else but this cotton. It has enabled 
me to do almost entirely without pes- 
saries. I use this treatment in cases 
where Dr. Emmet recommends hot 
water and iodine. It is ver}^ much 
quicker in its action than the latter 
method, and mstead of the patient 
being kept in bed, she is enabled to go 
about. 

I often use bismuth on these pledgets, 
as it is a good antiseptic; also other 
substances, such as iodoform, balsam 
of Peru, etc. — The Medical Record. 



The Treatment of Comedones. 
— After I had administered ether to a 
patient who was greatly affected with 
comedones, I noticed that they were 
easily pressed out, due, perhaps, to the 
solvent properties of ether on these 
greasy concretions. I resolved to give 
the ether treatment a fair trial. I used 



the following on several cases with 
gratifying results: 

R. Sulphuric ether, i ounce; 

Carbonate of ammonia, i dram; 

Boracic arid, 20 grains; 

Water, to make 2 ounces. M. 

Ayply twice a da}-. The carbonate of ammo- 
nia with the grease forms a soap. The boracic 
acid acts as an antiseptic, and the ether as a 
solvent. — Canada Practitioner. 



The Peoria Medical Monthly. 



TRANSCRIPT PUB. CO., Publishers. 



THOMAS M. McILVAINE, A. M., M. D., Editor. 



***The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

%*!{ extra copies are desired by a contributor, the number must be specified when the article is sent to the 
Editor. 

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addressed to the Editor. 

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lishers. 

***The publication day of this journal is on or about the 15th of each month. 



EDITORIAL. 
A CONTEMPTIBLE PRACTICE. 



Within the past few years we have 
frequently heard the remark made by 
patients: "Mrs. S. employs Dr. X. 
because he has studied both kinds of 
medicine, and can prescribe both old 
school and homoeopathic remedies." 
Sometimes we ard informed that " Dr. 
N. has three diplomas, and can doctor 
any way his patients wish." These 
statements are evidently authorized by 
the manifold doctor, and are probably 
intended to be passed from mouth to 
mouth by garrulous women as a good 
advertisement. 

That such claims do frequently influ- 
ence patronage, is doubtless true; but 
that the patient is ever benefitted by 
their liberty in choice of medicines to 
be employed, is greatly to be doubted. 
We claim, without fear of contradic- 
tion, that this practice is one of the 
most contemptible that can be adopted. 
The quack who comes boldly out and 
and advertises his skill in curing dis- 
ease, is not to be feared half as much 
as the quack who, under the quiet garb 
of a familv practitioner, knowingly de- 



ludes the people who employ him /or 
the money there is in it. 

The out-and-out homoeopothist, who 
practices according to the principles of 
his school, — narrow-guage though it 
be — or the eclectic who is honest, may 
be gentlemen, and however much we 
deplore their narrow-mindedness, we 
must give them credit for being honest. 
But when these men undertake to pre- 
scribe remedies with whose action they 
are not familiar, and declare themselves 
competent to treat disease according to 
all schools and pathies, they place 
themselves in a most contemptible po- 
sition before all thinking men. Yet it 
is worse, if possible, for a regularly 
educated regular^ or old school., as they 
are called, to make these claims. It is 
his right to employ any and all reme- 
dial measures with which he is ac- 
quainted, whether they be claimed by 
homoeopath, eclectic, botanic or old 
granny-woman, so long as he does so 
with an intelligent appreciation of the 
benefit his patient will have; but when 
he falls from this high position, and 



PV/iy there are so Many Medical yournals. 



333 



panders to the prejudices and whims of 
the people, by claiming to be able to 
practice according to their desires, he 
becomes almost beneath contempt. 

We have watched the career of sev- 
eral such of both classes, and they have 
ended disasterously in almost every 
case. People like to be humbugged, 
but it must be done in a shrew^d way, 
so the}^ cannot see through the scheme, 
for just as soon as they discover the de- 
ception, they have no further use for 
deceiver. 

On the other hand, this deception 
acts disasterously upon the victims who 
are thus gulled by the false pretences 
of these bastard practitioners. Valu- 
able time is lost, and oftentimes the 
disease has progressed far towards a 



fatal termination before the patient or 
his friends become aware that they are 
trusting in a false teacher. 

Physicians should endeavor, as op- 
portunity permits, to impress upon the 
minds of their patrons that regular 
medicine is not a pathy ; that all schools 
are open to it; that the whole range of 
therapeutic measures is open to their 
use, and that whatever is proven to be 
of benefit to suffering humanity is per- 
mitted to them to use. Were this 
done, the class of frauds we have writ- 
ten about would soon decrease in num- 
bers and influence, and the salutary 
effect upon the community would be 
noticeable in no very long space of 
time. 



WHY THERE ARE SO MANY MEDICAL JOURNALS. 



The question is often asked, how is 
it possible for so many medical journals 
to exist, much less to prosper? And 
at first glance it seems difficult to an- 
swer; but, upon reflection, we believe 
the solution will be found in the fact 
that the journals supply that in which 
text-books and encyclop£edias are lack- 
ing. 

Take the practice of general medi- 
cine, for example: diseases are named 
and under that name they are treated. 
Space may be devoted, in the works on 
Practice, to some consideration of the 
principles of medicine, and to the dif- 
ferential diagnosis, but it is to the dif- 
ferential diagnosis only, you will ob- 
serve, of those diseases which are 
named, and rarely, if at all, to those 



conditions w^hich cannot be specifically 
classified and named. 

The great want — the long-felt want 
— of a large proportion of physicians, 
is for a work, or works, w^hich will 
discuss diseased conditions, copiously 
illustrated by reports of cases; and 
when this is supplied it will be as much 
more satisfactory to the average doc- 
tor as is the clinical method of teaching 
to the old didactic system that is now 
tottenng upon its last legs. 

Until such a work is furnished, if 
indeed it be possible to write such an 
one, medical journals come the nearest 
to supplying this demand; and in this 
we believe lies the reason why journals 
are so liberally patronized. 

Another reason is, that they afford 



334 



Editorial. 



opportunity for the interchange of ideas 
and experiences among physicians, and 
this benefit no other means can supply. 
Yet if the first mentioned were not the 



paramount reason, the number of jour- 
nals would be not nearly so large, be- 
cause the patronage received would 
not warrant the publication. 



DRUGGISTS AS DOCTORS. 



A question had been brought up, 
under the new Medical Practice act, 
which is said to be giving the officers 
of the State Board of Health no little 
perplexity. It is the right of druggists 
to be registered as physicians under 
the provisions of the law of 1877. 

At first glance the thmg seems so 
preposterous as to be ridiculous; but 
the claims of certain prominent drug- 
gists of Chicago are stated with such 
earnestness of purpose as to lead to the 
conviction that they mean to do so if 
they possibly can. 

A. E. Ebert, a druggist of Chicago, 
who is also a Professor in a College of 
Pharmacy, and a member of the IIH- 
nois State Board of Pharmacy, is at 
the head of this movement, and is said 
to be backed up in it by a large num- 
ber of Chicago druggists, who say that 
if their demands are not complied with 
they will take the matter to the courts. 

The objectionable part of the new- 
Medical act is Sec. 10, which defines a 
practitioner of medicine as any person 
"who shall treat, operate on or pre- 
scribe for any physical ailment of an- 
other," and provides a penalty of $100 
for anyone who shall be convicted of 
practicing unlawfully — that is, without 
registration. 

Mr. Ebert openly acknowledges the 
charge made against druggists of coun- 
ter-prescribing as follows: 



" You must know," he said to a re- 
porter for the Chicago Tribune, "that 
the bulk of the business of the average 
druggist — at least two-thirds of it — is 
derived from the prescriptions which 
he himself puts up to persons calling 
for remedies for simple ailments. If a 
man feels a little indisposed from con- 
stipation, or has a headache, or asks 
for a remed}' for inflamed eyes, any 
druggist who understands his business 
can give him relief without his going 
to a doctor." 

This is a broad, fair statement of the 
position maintained by a very large 
proportion of druggists. They have 
the inalienable right to prescribe for 
any person applving to them. 

When doctors deny this right, the 
druggists ask, "What are you going 
to do about it?" and if they succeed in 
this latest demand, the doctors might 
as well take down their shingles. 

We have always claimed that drug- 
gists did a very large amount of coun- 
ter-prescribing, but we had no idea 
that it assumed the proportions admit- 
ted by Mr. Ebert, reaching two-thirds 
of the business of the average druggist. 
If this be the true status of affairs, the 
sooner the penal provisions of the Med- 
ical Practice act are put into execution, 
the better it will be for the people who 
are being swindled by counter-pre- 
scribing druggists. We believe the 



Editorial Mention. 



335 



State Board of Health will not comply 
with these arrogant demands of Ebert 
and his confreres, and the physicians of 
the State will uphold it in anv conflict 
into which it may be draw^n. Should 
it be necessary, sufficient additional 
legislation can be secured to strengthen 
the medical law, for the 6,000 physi- 



cians of this State can, if united and 
determined, accomplish almost any- 
thing they may undertake. 

We shall certainly keep our readers 
posted upon this matter, and the decis- 
ion of the State Board of Health will 
be looked to with great interest. 



EDITORIAL 

Dr. Charles T. Parkes has been 
chosen as successor to the late Dr. 
Moses Gunn as Professor of Surgery 
in Rush Medical College. Dr. Parkes 
has long been widely known as the 
able Professor of Anatomy in that in- 
stitution, and his elevation to the higher 
chair is but a just recognition of his 
services and great merit. 

Dr. Parkes' successor in the chair of 
Anatomy is Dr. A. D. Bevan, late 
Passed Assistant Surgeon in the Ma- 
rine Hospital Service and Professor of 
Anatomy in the Williamette University, 
Portland, Oregon. He is a graduate 
of the class of 1883 or 1884, and is said 
to be a ver\' promising teacher. 

It was thought by many that Dr. A. 
B. Strong, for many years Demonstra- 
tor of Anatomy and Lecturer in the 
spring course, would be Dr. Parkes' 
successor, apd his long connection with 
the college and attainments as an an- 
atomist would seem to have been suffi- 
cient reason for his advancement, but 
the college authorities though tother- 
wise, and Dr. Strong has severed his 
connection with the college. 

We regret to notice the death of Dr. 
Wesley M. Carpenter, of New York, 
who died suddenly, in that city, Jan. 7. 

Dr. Carpenter was a valued member 



MENTION. 

of the editorial staff of the Medical 
Record, and, as its chief reporter, w^as 
well known to many who have attended 
the meetings of the various large medi- 
cal societies throughout the country. 
His greatest work was the report of 
the meeting of the International Con- 
gress, and it was by far the most satis- 
factory report of that meeting given to 
the profession. He was also secretary 
to many New York societies and a 
contributor to medical literature. He 
will be greatly missed, and his place 
will be hard to fill. His age was about 
50 years. 

There remain about three and one- 
half months before the meeting of the 
Illinois State Society at Rock Island, 
and in this short time all must be done 
to make the coming meeting that suc- 
cess which the past two or three meet- 
ings have not been. Whether anything 
is being done to incite interest in the 
society and call out a large attendance, 
w^e do not know. We have repeatedly 
asked for the views of our readers on 
the methods best adapted to this de- 
sirable end, but as yet we have had no 
response, and are almost forced to the 
conclusion that the physicians of this 
State do not take any interest in State 
Society work. Is this true ? 



336 



JVotes and News. 



NOTES AND NEWS ITEMS. 

From the American Lancet. 



New York City has one hospital bed to 
every two hundred and sixty inhabitants. 

On Oct. 24 the British Medical Journal re- 
ports a death at Westminster Hospital from 
chloroform. 

Mr. E. Painter says that there are in the 
market thirty-six thousand five hundred pro- 
prietary medicines. 

Fifty dollars is charged by the London cre- 
mation society. In Detroit only twenty-five 
dollars is charged. 

Dr. Grant Bey, of Cairo, Egypt, says that 
we have a continuous history of medicine for 
nearly six thousand years. 

A Los Angelos doctor received one thousand 
dollars for attending a case of confinement at 
his old home in Kansas. 

It is sought to establish in Philadelphia a 
new medical college, to be known as the Burton 
Medical College. 

A colored woman, Madame Sollier, has re- 
ceived the degree of Paris Faculty of Medicine. 
She is the wife of a blonde French doctor. 

Sir Andrew Cl.a.rk, of London, said: "I 
worked twelve years for bread, twelve for butter 
and twelve more for the luxuries of life." 

The garbage, etc., of Montreal is cremated at 
an expense of forty-three- thousand dollars a 
year. 

The process of embalming in its best form, 
as practiced b}' the ancient Egyptians, cost more 
than two thousand five hundred dollars. 

The statistics of the English Registrar Gen- 
eral shows that 1885 was an exceptionally 
healthy year, doubtless due to the increase of 
obedience to sanitary laws. 

In twenty-eight hospitals of New York there 
was reported a deficiency of three hundred 
thousand dollars. This amount must be made 
good by private contributions. 

It is said that the Government employees at 
Washington cannot draw their pay for the time 
they have been absent on account of sickness, 
unless the doctor says so. Hence, all such per- 
sons pay their doctors with promptness. 



Some able neurologists believe that compres- 
sion of the head during birth is responsible for 
very many cases of impaired cerebral function. 

The Medical Advance tells of a man who, 
when traveling, selects as his doctor in a given 
place the man who takes the largest number of 
medical journals. Such a doctor he regards as 
well read and so competent to treat his family. 

The French people are said to suffer in a 
great degree from constipation . This is ascribed 
to their lack of love for out-door athletic sports 
and imperfect water-closets. As a result, they 
devise the most palatable laxatives and purga- 
tives. 

Manetho, writing two hundred and fifty 
years B. C, states that King Teta, the second 
king of the first Egyptian Dynasty, four thou- 
sand years B. C, wrote treatises on anatomy 
and surgery and performed surgical operations 
with flint flakes. 

A Carlsbad cure combines a rest cure, a diet 
cure, an air cure, a music cure, a mind cure and 
a body cure. Its efficiency depends upon the 
intelligent skill with which all these are brought 
to bear with varying degrees of force upon each 
separate individual. 

The epidemic of typhoid fever in Cincinnati 
is said to be caused by the low state of the Ohio 
river, which concentrates the sewage into rela- 
tively small amounts of water. Boiled water is 
the popular beverage in that city. The bacillus 
of typhoid fever has been demonstrated in the 
water offered for drink in the public reservoirs. 

The editor ot the St. Louis Medical and Stcr- 
gical Journal says that he heard a prominent 
druggist in St. Louis say to his. clerk that Dr. 

, of Washington avenue, told him that 

he was getting three hundred dollars a year for 
his prescription trade, and he could not afford 
to change druggists unless he was paid five hun- 
dred dollars. 

The indabitants of Newark and Jersey City 
drink the water from the Passaic river, and so 
must consume the sewage of the towns, etc., 
whose filth empties into the river above the 
place where it is taken to supply said cities. If 
cholera discharges should chance to enter the 
the river far up, it would soon be apparent that 
evil was hidden in this water. 



lATM. R. WARNER & GO'S 



SOLUBLE COATED PILLS 




(C H I,) 



.A^IiT XJ^F0:RT J^ISTT 



Therapeutic Agent 



A POWERFUL ALTERATIVE AND GENERAL TONIC, 



VALUABLE AS A REMEDY IN 



SCROFULA, AN^^MIA, NEURALGIA, CHLOROSIS 
AND RHEUMATISM. 



Iodoform therapeutically is alterative, nervine, sorbefacient, anti-periodic and 
anaesthetic. As an alterative it acts with more rapidity than other medicines of that 
class, in doses of one, two or three grains, repeated thrice daily. As a nervine it is 
prompt and efficient ; while it gives nervous strength, it calms speedily the most severe 
pains. Its sorbefacient properties are manifested with some degree of slowness. Five 
to seven grains, given in broken doses in rapid succession, produce a powerful anti- 
periodic effect. 



Philadelphia, yaniiary lo, 1880. 
I have used and prescribed the Sugar-Coated Pills of Messrs. Warner & Co., and can testify 
to their solubility, as far as those which I have used may be mentioned. I find them as prompt 
and efficient as those prepared by the formula of the U. S. P. and uncoated. 

B. HOWARD RAND, M. D., Prof. Med. Dept. University, Pennsylvania. 



g^"In ordering or prescribing preparations of Iodoform, specify (Warner & Co.,) 
otherwise disappointment may follow from substitution. "^g 



IMPORTANT TO PHYSICIANS ! 



WE take pleasure in presenting to the Medical Profession the follow- 
ing Pills of Iodoform and its combinations. Since its introduction 
by us in 1871, it has grown in permanent favor as an indispensable 
remedy, possessing the properties of a powerful alterative, nervine, anti- 
periodic and tonic. The following formulae, (the coating of which will 
dissolve in three and one-half minutes and the substance of the Pill in 
a short time after), are ready prepared for physicians' prescriptions, and 
we trust will meet with their various requirements. 



lodofora, 1 gr. 

Med. prop. — Tonic, Alterative. 

Pil: Iodoform etFerri. 

(WARNER & CO.) 
Med. prop. — A powerful general tonic 
and alterative; valuable as a remedy in 
Anzemia, Scrofula, Neuralgia, Chlorosis, 
Rheumatism, etc. 

Iodoform, i gr. 

Ferrum per Hydg., i^ gr. 

Iodoform et Ferri et Nnc. Vom. 

(WARNER & CO.) 
Med. prop. — Tonic, Alterative. 
Iodoform, i gr. 
Ferri Red, i gr. 
Ext. Nuc. Vom., % gr. 

Iodoform et Bydrarg. 

Med. prop. — Alterative. 
Iodoform, ^ gr. 
Mercury Proto. lodid., yi gr. 


Iodoform et Nuc. Yomica Comp. 

(WARNER & CO.) 

Med. prop. — Alterative, Tonic, Laxa- 
tive, Repellant. 

Iodoform, y^ gr- 
Ext. Nuc. Vom., yi gr. 
Podophyllin, Jg gr. 
Ext. Belladon., yi gr. 

Iodoform et Quinine. 

(WARNER & CO.) 

Med. prop. — Alterative, Tonic. 

Iodoform, y^ gr. 
Quinmae Bisulph., ^ gr. 

Iodoform et Quinina et Ferri. 

(WARNER & CO.) 

Med. prop. — Tonic, Alterative. 

Iodoform, i gr. 

Ferri Carb. > Vallet's), 2 grs. 

Quininae Sul., yi g^. 



PRKPARED BY 



WM. R. WARNER & CO. 



SUPPLIED UPON PHYSICIANS' PRESCRIPTIONS 
BY ALL LEADING DRUGGISTS. 



Specify (Warner & Go.) when Ordering or Prescribing. 



TO THE MEDICAL PROFESSION. 



THE MOST PERFECT SYSTEM OF DOSIMETRY 



IS AFFORDED BY 



-<1PARVULES>- 



The term Parvule, from Parvuin (small), is applied to a new class of remedies 
(Warner & Go's) in the form of minute pills, containing minimum doses for frequent 
repetition in cases of children and adults. It is claimed by some practitioners that small 
doses, given at short intervals, exert a more salutary effect. Sydney Ringer, M. D., in 
his recent works on Therapeutics, sustains this theory in a great variety of cases. 



CALOIMEL JLNT) IPECJLC. 

R Calomel, 1-10 gr. Ipecac, 1-10 gr. 

Med. Prop. — Alterative, Purgative. 

Dose. — i to 2 every hour. Two Parvules of Calomel and Ipecac, taken eveiy hour, until five 
or six doses are administered (which will comprise but half a grain of Calomel), produce an activity 
of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains 
of Blue Mass or ten grains of Calomel rarely cause, and sickness of the stomach does not usually 
follow. 

PARVULES ARSENIT: POTASH, 1-100. 

(WARNER & CO.) 

This Parvule will be of great use to physicians, as two Parvules represent the 
equivalent of one drop of Fowler 'S Solution , so that physicians can regulate 
the dose by giving one or more Parvules every hour. 



PARVULE CORROSIVE SUBLIMATE, MOO. 

(WARNER & CO.) 

Dr. Ringer, in his treatise, lays great stress upon the efficacy of minimum doses of 
corrosive sublimate in the treatment of Diarrhoea, whether the stools contain blood or not. 



PARVULES NUX VOMICA, 1-50. 

(WARNER &. CO.) 

Nux Vomica, according to Ringer, is possessed of real curative powers for sick 
headache, accompanied with acute gastric catarrh, whether due to error in diet, constipa- 
tion, or no apparent cause. He regards it, administered in small and frequently repeated 
doses, as useful in many disturbances of the gastric function. 

PREPARED BY 

IfiTM. R. WARNER & CO. 

Supplied upon Physicians' Prescriptions by ali Leading Druggists. 

So as not to be disappointed in their tlierapeutic effect, 
see tliat Pink Granules are not substituted. 



Iqlei of Diseases Tieatei wilti Panules. 



THE dose of any Parvule will vary from one to four, according to age 
or the frequency of administration. For instance, one Parvule every 
hour, two every two hours, or three every three hours, and so on, 
for adults. For children, one three times a day is the minimum dose. 

It is claimed by many practitioners that small doses, frequently repeated^ 
exert a more salutary effect. 



Atonic Dyspepsia. 

Parv. Nux Vomica, 1-50 gr. 

Bilious Coiiflitlons. 

Parv. Calomel, 1-20 gr. 

Bronchitis of Children. 

Parv. Tartar Emetic, i-ioo gr. 

Constipation. 

Parv. Aloin, i-io gr. 

Diarrhoea. 

Parvules Corros. Sublimate, . . i-ioo gr. 

Kxantheinatous Slcln Disease. 

Parv. Iodide Arsenic, i-ioo gr. 

Habitual Constipation. 

Parv. Podophyllin, 1-40 gr. 

Hydatic Uterine Gro^vth. 

Parv. Ergotine, i-io gr. 

Incontinence of Urine. 

Parv. Canthan 1-50 gr. 

Inflammatory Process. 

Parv. Aconite, 1-20 gr. 

Influenzas. 

Parv. lod. Arsenic, ...••.. i-ioo gr. 

Itching: Skin Eruptions. 

Parv. lod. Arsenic, i-ioo gr. 

9IUCOUS Rectal Dischar}j:es. 

Parv. Tannin, i-io gr. 



3iausea. 

Parv. Ipecac, 1-50 gr. 

Retarded I>Ienstruation. 

Parv. Ergotine, i-io gr. 

Scrofula. 

Parv. Calomel, 1-20, and Aloin, . i-io gr. 

Sick Headache. 

Parv. Nux Vom 1-50 gr. 

Sickness of Pregnancy. 

Parv. Belladonna, 1-20 gr. 

Slusrsish Bo^vels. 

Parv. Podophyllin, . 1-40 gr. 

Sperniatorrhcea. 

Parv. Phosp., 1-200 gr. 

Summer Diarrhoea. 

Parv. Mercury with Chalk, . . i-io gr. 

Syphilis. 

Parv. Calomel, 1-20 gr. 

Syphilitic Headache. 

Parv. Cor. Subl., i-ioo gr. 

Torpidity of I^iver. 

Parv. Podophyllin, 1-40 gr. 

Uterine Hemorrhas^es. 

Parv. Ergotine, i-io gr. 

Vesicular Hmphysema. 

Parv. Digitalis, 1-20 gr. 



WM. R. WARNER & CO. 



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Preparations Supplied upon Physicians' Prescriptions by all Leading Druggists,. 



Periscope. 



337 



PERISCOPE. 



Remedies for Hyper-emesis. — 
Dr. V. H. Moore says : " I have been 
using the nitrate of potash as an anti- 
emetic in my practice for the past 
twelve years, with the happiest results. 
The manner of administering it is as 
follows: give one-quarter of a grain, 
dissolved, in a table-spoonful of cold 
water, every four or five mmutes until 
the vomiting is relieved, which will 
usually be in from ten minutes to half 
an hour. I give it in all cases of vom- 
iting, except reflex, and that due to 
irritant poisons, and have found it suc- 
ceed in ninety per cent of my cases. 
It is pleasant to take, rendering it more 
valuable in nausea and vomiting in 
children." 

Dr. Jennings advises the adminis- 
tration of ten minims of a four-per-cent 
solution of cocaine by the mouth, in a 
little water, every hour, as a reliable 
mode of stopping the vomiting in yel- 
low fever. 

Dr. W. D. Jones reports the fol- 
lowing case: " I was consulted regard- 
ing the patient, who had retained no 
food for five days, and was threatened 
with starvation. I recommended quar- 
ter grain doses of cocaine in combina- 
tion with subnitrate of bismuth and 
acid carbolic., with mucilag. acaciee, to 
be taken thirty minutes prior to some 
light nourishment. The patient has 
had very little trouble since. The 
cocaine was soon withdrawn, and the 
case progressed nicely. 

" It must not be forgotten in connec- 
tion with the case, that prior to the 
pregnancy just spoken of, two abor- 
tions were performed to save the 
patient from starvation." 

Sudden Death After Ureth- 
ral Injection. — A physician cut a 
slight stricture of the urethra about 
three-quarters of an inch behind the 
meatus. It was done under cocaine 
without trouble or pain. The doctor 



had the patient come to his office 
every second day to pass a sound, and 
each time give him an injection of a 
four per cent cocaine solution, about 2 
drams, before introducing the sound. 
On the seventh day after the cutting 
the patient complained of being very 
nervous; had been nervous for several 
days and had not slept at night. The 
sound was introduced that day under 
cocaine as before. On the ninth day 
he returned, and an injection of co- 
caine was given. The patient reclined 
on an ordinary office chair, and the 
doctor turned away to procure his 
sound and warm it while the cocaine 
should exercise its influence on the 
urethra; in less than a minute after 
the cocaine was given the patient com- 
plained of dizziness and fell back on 
the chair. Another physician in the 
outer office was called, and together 
they did what they thought necessary, 
administering stimulants, and using a 
galvanic current, but in three or four 
minutes after the injection was given 
the young man was dead. He was 
about 28 years of age, and had been in 
good health so far as is known. At 
the post-mortem examination the body 
was thoroughly examined, the brain 
included ; there was absolutely nothing 
abnormal found except that the kidneys 
were excessively congested; they were 
so blue that they looked like an ordi- 
nary spleen. The cause of death is 
open to conjecture; probably the pa- 
tient was suffering srom uraemia, and 
any irritation of the urethra would 
have provoked the result; certainly 
death could not have resulted from 
cocaine poisoning, since sufficient time 
for its absorption and circulation had 
not elapsed: nor is it plausible to as- 
sume that there had been an accemu- 
lation of the drug from the previous 
urethral injections. Doubtless an in- 
jection of distilled water would have 
provoked the same result. Whether 



338 



Perisc(ype. 



the urine had been scanty or albumi- 
nous the attending physician could not 
say. — your. Am. Med. Ass'n. 

F^CAL An.^mia. — The production 
and treatment of anaemia and chlorosis 
in girls and young women from 14 to 
24 years of age formed the subject of 
the paper. He had studied many 
years ago the results of retention of 
the excretions and the effects of their 
decomposition. He described the pe- 
culiar and characteristic symptoms of 
those forms of anaemia or chlorisis 
which occur in young women, which 
he ascribed in a large number of cases 
to tee accumulation in the large intes- 
tines of faecal matter, its decomposi- 
tion, and the consequent absorption of 
the poisonous products so formed. He 
pointed out that the bowels might be 
open daily, but imperfectly; so that 
even where constipation was said not 
to exist, faecal retention nevertheless 
might and did take place, with the 
evil results alluded to. The condition 
was one which was not confined to any 
particular class of society; it occurred 
in the underfed and the overfed, in the 
rich and poor alike. Girls at pubert}^ 
began to think more about their per- 
sonal appearance; they ceased to take 
the same active exercise as before: 
they pinched in their waists and devel- 
oped a self-consciousness in all their 
acts which led to their being very shy 
about going to the closet. He quoted 
the researches on the subject of the 
formation of alkaloids in the intestines, 
and urged that everything pointed to a 
toxic absorption. In collateral proof 
of his assertion he instanced the almost 
invariable success which attended the 
administration of aperient iron mixtures 
which unloaded the bowels and re- 
stored things to their normal condition. 
He discussed the dietetic and medici- 
nal treatment of such cases in detail, 
and pointed out that aperients were 
even more essential than ferruginous 
preparations. In patients who had 



been treated without success for 
months a cure was rapidly effected if 
these principles were borne in mind. — 
Br. Med. Jour. 

Strange Scene at a Fire. — At 
the burning of the Homoeopathic Med- 
ical College at Cleveland, Ohio, De- 
cember 17th, the firemen were fighting 
the flames at close quarters, when sud- 
denly, to their consternation, the nude 
bodies of five persons came sliding 
through a hole which had been burned 
through the floor over their heads. 
When the men recovered from their 
astonishment the bodies were dragged 
out of the room and strenuous efforts 
made to resucitate them. A physician 
opportunely arrived to inform them 
that the bodies they were so nobly at 
work upon were subjects that had 
been dead a week or more, and be- 
longed to the dissecting department, 
the fire having burned through the 
floor of the dissecting-room and par- 
tially destroyed the supports of the 
table on which the cadavers lay, caus- 
ing it to incline toward the hole. 

Salol in Typhoid Fever. — Dr. 
James Barnsfather, of Dayton, Ky., 
says that in all the cases of typhoid 
fever I attended this fall, in addition to 
the usual treatment, I prescribed the 
new synthetical compound, salol (sali- 
cylate of phenol), from the very com- 
mencement, and continued it to con- 
valescence, in doses of three grains 
every three hours, with the happiest 
results so far. It seems to have a pow- 
erful action upon the leucomaines 
formed during the progress of the dis- 
ease, evidently destroying to a certain 
extent their toxic action on the nervous 
centers (if I am to judge by results.) 
It is eliminated by the kidneys, and in- 
creases the flow of urine. I may also 
state that in none of my patients was 
the stomach disturbed by the small 
doses given. — New York Medical 
yournal. 



Advertisements. IS 

NEW REMEDIES I ^^^^^ 



PIL. TERPIN HYDRAT. "W. H. S. & CO." 2 GRAINS EACH. 

A newMd potent remedy in the treatment of coughs, catarrh, bronchitis and kindred diseases. 
T Terpin Hydrate IS in the form of colorless moaoclinic crystals, melting at 100° 0., and has the composition Co H,a 
JL 3 rl2 O. 

It was first prescribed in France by Lepine, who recommended it as an expectorant. Guelpa took 4 grammes in 
iz hours, and Jeanne! prescribed 2 grammes per day, for severel weeks in succession, without the least sign of intoler- 
ance. Jeannel and See found it useful in Broncliial afleetions, and Vigier, in the same disease, recommends it to be 
taken in pills to the exte:it of 1 or 2 grammes per day. 

Dr. Halstead Boyland {vide ''The Medical Record," Sept.SU, 18S7,) speaks very entusiastically of Terpin Hydrate, 
and after quoting several cases in which it has been exhibited with marked success, thus concludes: "Jt has proved 
eminently satisfactory in my hands in every case in which I have used it, and I now prescribe it freely in all Coughs, 
Colds and Catarrhal affections, as well as in Bronchial troubles generally, wherever elimination is indicated and 
should advise its administration in Asthmatic Dyspncea, in^doses of 2 grains every 15 minutes, until 10 grains have 
been taken or relief had been obtained. Jt has already proved itself of great utility in the treatment of diseases of the 
respiratory tract, and must be conceded to be a valuable addition lo the Pharmacopceia " 

We have submitted our Pills of Terpin Hydrate to physicians of eminence, and from all who have had opportuni- 
ties of trying them, the remedy has received their unqualified approval. 

In a case of Chronic Bronchial Catarrh, the patient being a very stout lady, the relief was immediate, the cough 
easier, sleep quite normal and expectoration free. 



PIL. HYDRARGYRUM TANNEGUM OXYDULATUM. "W. H. S. & GO." 

(MURCURY TANNATE ) I GRAIN EACH. 

Murcury Tannate was first prepared by Dr. Sigmund Lustgarten, in the Pathologic-Chemical Institute of Prof. E 
Ludwig, in Vienna. 

It is a grayish-green powder, containing at least 40 per cent, of Mercury, and is absorbed by the system with great 
rapidity, due to the fine separation of the Mercury; at the same time it is free from the disagreeable symptoms accom- 
panying the use of other mercurial preparations. 

Dr. Lustgarten submitted his experience with Mercury Tannate to the Imperial and Royal Society of Physicians 
in Vienna, January 4, 1887, showing that it possessed mild anti-syphilitic properties, seldom producing Balivation, 
stomatitis or diarrhcea, which so often follow the administration of the Chloride, Bi-Chloride, Protiodide, and Binio- 
dide forms of Mercury, 

Doctors Shadeck, Leblond, Dornig, Pearson, Bowrowski and Lesser, and Professors Lang and Finger, all write 
approvingly of Tennate of Mercury. 

We have placed the Hydrargyrum Tannicum Oxydulatum in the hands of several eminent physicians Connected 
with hospitals in New York, for trial, so that a verification migllt be obtained of the foregoing testimony. From re- 
ports already received, it seems well worthy of a more extended trial. We now offer it to the medical profession la 
the form of our soluble pills, containing one grain each. 

O 



PIL. SALOL. "W. H. S, & GO." 2 ^ AND 5 GRAINS EACH. 

The new remedy for rheumatism and rheumatic affections, possessing all the advantages of Salicylic Acid and 
Salieyate of Soda, while not causing any of their objectionable effects. 

This valuable remedy was introduced by us to the medical profession several months since, to whom we offered 
it in pill form, in strengths of 2J4 and .5 grains to each pill. 

"Salol," or "Salicylate of Phenol," was first introduced by Prof. Von Nencki, of Berne, and first brought to the 
attention of the medical profession in a communication by Dr. Sahli to the Medico-Pharmaceutical District Society of 
Berne, at its meeting held in that city, on April 6, 1886. 

Salol is composed of 50 per cent, of Phenol (Carbolic Acid) and 60 per cent, of Salicylic Acid; a very faint odor of 
Carbolic Acid is characteristic of pure Salol. 

Our pills of Salol were first submitted to the most eminent practitioners of New York and Brooklyn for the purpose 
of determining their properties by practical tests. 4®"And from all, without exception, who had an opportunity of 
making a trial, we received the assurance that its action was successful and speedy, and free from the objectionable 
effects of the Salicylic Salts, j^* 

These physicians tested it not only upon their patients, but upon themselves, and the prevailing opinion was that 
the best results were obtained from doses of 5 grains every hour at first; afterward the same quantity every other hour. 

Since then Salol has attracted very great attention, and the experience of the profession abundantly confirms the 
original testimony as toils phenomenal curative properties in Rheumatism and RheuTiatic affections. 

It has also been demonstrated that the use of Salol in the treatment of Sciatica, Diabetes and Diarrhcea has met 
a marked success. 

We are now revising our TREATISE on Salol, in which we intend to incorporate the latest experience acquired 
in the treatment of the several diseases for which Salol is indicated. 

This TREATISE will be mailed on application. 



W. H. SCHIEFFELIN & CO., 

170 and 172 William St., 3fEW YORK. 



In Prescribing, be Particular to Specify "fF. H. S. & Co^s." 



14 



Advertisements. 



iATE City Stone Filter Co. 

46 MURRAY ST., N. Y. 

Fine China and Gray Stone Ware Jars to Hold 

tite Water. 

'^^A Natural Stone filtering medium. 

Fitted with Separate Patent Ice Chambers 
to Cool the Water. 

«: As easily Cleansed as a Water Pitcher 

I^^No Metal or other Objectionable Material used inlthe 
Construction of this Filter. 

Ail Water is Filled With Impurities during the Rainy Season 
with the Washings of the Earth and Air. 

THIS FILTER WILL ABSOLUTELY CLEAN IT. 




.:W 



Cheapest, Most Ornamental and Best Filter for Office 
and Family Use on the Market. 

Address as above for Descriprive Price List. Mention this Journal. 



A New Oxycen Apparatus 

Just what every 
physician needs 
and lias been wait- 
ing' for. 

Neat. Compact, 
Portable, Efficient, 
Durable, Complete 
with 10 gall. Kub- 
ber Gas Holder, In- 
haling Tube and 
3Iouth-piece 

Yields 10 gall, 
pure and Dry Ox- 
ygen at each oper- 
ation, which may 
be repeated as of- 
ten as desired. 




Size of Case, 16x11x8 inches.— Patent Applied for. 



Price, in Handsome Case, with One DozenC barges Prepared Material. Equal to 120 Gallons Pure Oxygen, $35.00 

The Wallian Oxygen App. M'f'c Co., 

119 East 28th Street, New York. 



Advertisements. 



15 





CHICAGO, ILL. 




The forty-fourth Annnal Session of Lectures will begin in the latter part of September, 
and will continue twenty-one weeks annually. 

The requirements for entering the College, and for obtaining the degree, are fully 
described in the annual announcement, which will be gent to any address upon appli- 
cation. 

A spring course of lectures is also given.. 



J. Adams Allen, M.D., L.L.D., President, 

Profesor of the Principles and Practice of Medicine. 

DeLashie Miller, Ph.D., M.D., 

Professor of Obstetrics and Diseases of Children. 

Joseph P. Boss, A.M., M.D., 

Professor of Clinical Medicine and Diseases of the Chest. 

W. E. By ford, A.M., M.D., 

Professor of Gynaecology. 

Edward L. Holmes, A.M., M.D., 

Professor of Diseases of the Eye and Ear. 

Henry M. Lyman, A.M., M.D., 

Professor of Physiology and Diseases of Nervous System. 

James H Etheridge, A.M., M.D., Secretary. 

Proft ssor of Materia Medica and Medical Jurisprudence. 
Charles T. Parkes, M.D., 

Professor of the Prin<dples and Practice of Surgery and Clinical Surgery, 

Walter S. Haines, A.M., M.D., 

Professor of Chemistry and Toxicology. 

J. Kevins Hyde, A.M.,M.D., 

Professor of Sisin and Veueral Diseases. 

Morman Bridge, M.D., 

Professor of Hygiene and Adjunct Irofessor of tlie Principles and Practice of Med.cine. 

E. Fletcher Ingals, A.M-, M.D., 

Professor of Laryngology. 

Truman W. Brophy, M.D., D.D.S., 

Professor of Dental Pathotogy and Surgery. 

Arthur D. Bnvan, M- D., 

Professor of Anatomy. 

For Further information apply to the Secretary, 

Dr. J. H. ETHERIDGE. 

1030 Michigan Avenue, Chkjafiro, IH 
Flease mention THE PEORIA MEDICAL MONTHLY. 



16 



Advertisements. 



"SUNNYSIDE," a Private Home 

DisemseB of Woimem amd Childrem. 




0^ 



|R. T. M. CULLIMORE has opened a Private Hospital 

with the best accommodations and facilities for the treatment 

ot diseases of women and children. The house is new and one 

of the best residences on West State Street, the most attractive street 

in the beautiful city of Jacksonville, 111. 

Each patient has a private room and quiet seclusion, witli all the 
(iniforts of fi home. Every endeavor will be made to furnish pa- 
tients with the best of care, and, in surgical cases, thorough anti- 
■^(.ptic treatment and environment 

This establishment is in no sense a retreat or asylum, but a 
Home Hospital for Ladies of the better class who suffer from any of 
the numerous diseases peculiar to women, and for the treatment 
and management of chronic conditions Incident to childhood. Special 
•ittention will be paid to the use of Electricity, Baths, Massage and 
other conservative gynsecological measures now so successfully used. 
The fact that it is impossible to attain the best results from these 
measures unless the patient be under the constant care of a physician in a well regulated Hospital, is the warrant for 
the projection of this enterprise. Where surgical procedures are required they will be advised and carried out. 

De. CtTLLiMOEE has recently returned from New York and Boston, where he has, at considerable expenditure of 
time and money, made special preparation for the line of work indicated, and hopes to merit the esteem and co-op- 
eration of the medical profession as well as those who place themselves under his care. 
For'Further Information, address 

T. "^/L. Oiallizinore, 3ivd:. 3D-, 
Or NIISS VESTA KILPATRICK, Matron. S5s Wesi state street, Jacksonville, ill. 

ARTIFICIAL LEGS^ndARMS 

WITH RUBBER FEET and HANDS. 



Although a man may meet with the misfortune of having both 
of his legs severed from his body, he is not necessarily helpless. 

By having artificial legs with rubber feet applied, he can be 
restored to his usefulness. 

The enoraving is from an instantaneous photograph of a man 
ascendiuo- a ladder. He has two artificial legs substituting his 
natural ones, which were crushed by a railroad accident and 
subsequently amputated. With his rubber feet he is able to as- 
cend or descend a ladder, balauoe himself on the rungs, and have 
his hands at liberty. He can earn a good day's wages at the 
bench. He can walk and mingle with per-ons without betray- 
ing his loss; in fact, he is restored to his former self for all prac- 
tical purposes. . . 

With the old methods of complicated ankle-joints an undertaking of this kind 
would be at the peril of the wearer, but with the rubber feet he can yenture into all 
sorts of operations with safety. ....,, . i- ». ,j ^ 

Over ei<^ht thousand in practical use, scattered in all parts of the world, irom 
whom uraises are daily received. Many of these have been made from measure- 
ments without the presence of the wearer. Our copyright formula, which anyone 
r^Ti easily till out, supplies all the data necessary. The press, eminent surgeons, 
aiid competent judges commend the rubber foot and hand for their remarkable 

E^'e^industrial exhibition where the rubber foot and hand have been exhib- 
ited has awarded the highest prizes. 

A laree illustrated pamphlet will be sent gratis. 

The rubber foot and hand have the endorsement of the U. S. Government, and 
are supplied to the cripples of the U. S. Army and Navy. 

A. A, MARKS, 701 Broadway, New York. 




Adve rtisements. 



17 



MARVELOUS 

MEMORY 



■Wholly unlike artifi4*i»l ^^ystems. 
Anj' book leai-Hecl in one I'eadins. 

Recommended by Mark Twain, Richard Proctor, the 
Scientist. Hons. W. W. Astor, Judah P. Benjamin, Dr. 
Minor, etc. Class of IdO Columbia law students; two 
olasses of 200 each at Yale; 400 at University of Penn, 
Phila., 400 at Wellesley College, and three large classes 
at Chautauqua University, etc. Prospectus post free 
from PROF. LOISETTE, 2.37 Fifth Ave., New York. 



FOR SALE. 

Extensive practice. Population 8oo. No 
competition; large country ride, within which 
is a town of 300 without a medical man. 

Property to sell — two houses and lots, office 
and horse and buggy, etc. Price for property 
I1400; no extra charge for good will; all I ask 
is pay for property. Reason for selling ill 
health. Length of time here nine years. No 
one need apply, except a good medical man, 
married, with cash to pay down. 
Address, 
J. M. ADAMS, M. D., Spencer, 111. 



DR. H. KRUSE, 



Specialist for Diseases of the 



EYE # EAR, 



313 SOUTH JEFFERSON ST. 



NKAU rilA NK l,IN ST., 



:e>jeio:eix..^. 



iXjX_.ii>rois 



OFFICE HOURS— 9 to 12 a.m., 2 to 4 p.m.; Sundays, 
9 to 10 a.m. 

Office will be removed about 1st of October to 109 S. 
Jefferson Street, over Dime Savings Bank. 



-P: 



^^ For Sale. 



Residence, officeand practice in thriving county seat town in southern Kan- 
sas. Good paying practice; little competition. Ill health reason for selling. 
For further particulars address box 78, Medicine Lodge, Kan. 



■*->-; 



->4 ROBERTS * FELLOWS I^CK,^ 




F 



Successors to EDW. L. WILSON. 

:F'TJBLISH:E!I^S OIF" CHIOIGIEl 






MANUFACTURERS AND DEALERS IN 






Ftiotograpliic Transparsudes !or tlis Optical Lantern. 



AGENTS FOR THE 



STEREOPTSGONS. SQIOPTICONS -^^ MICROSCOPES 

1125 CHESTNUT ST„ - PHILAOELPHIA, Pi 

Send 3-C. Stamp for Catalogue. Please Mention this journal. 



18 



Advertisements. 





Dr, McIntosBs 

N ATURAL ITTER INE — C UPPQRTER. 
ooooooooooooooo ^^^ ooooooooooooo g^^P ooooo ooooooooo 

No Instrument has ever been placed before the Medical Profession which has 
given such Universal Satisfaction. 



Every indication of uterine displacements is met by this combination; Prolapsus, An- 
teversion, Retreversion, and Flexions, are overcome by this instrument, when others fail. 

UNION OF EXTERNAL AND INTERNAL SUPPORT— The abdomen is held up by 
the broad morocco leather belt with concave front and elastic straps to buckle around the hips. 
The TJterme Support is a cup and stem made of highly polished hard rubber, very light and dur- 
able, shaped to tit the neck of the womb, with opening for the secretions to pass out. 

ADAPTABILITY TO VARYING POSITIONS OF THE BODY.— The oup and stem are 
suspended from the belt by two soft elastic Eubber Tubes, which are fastened to the front of 
the belt by simple loops, pass down and through the stem of the cup to the back of the belt,' 
and being elastic adapt themselves to all the varying positions of the body. 

SELF ADJUSTING. — One of the many reasons which recommend this Supporter to the 
Physician is that it is self-adjusting. 

It can be worn at all times, will not interfere with nature's necessities, will not corrode, and 
is lighter than metal. It will answer for all cases of Anteversion, Eetroversion, or Prolapsus 
of the womb, and is used by the leading Physicians with unfailing success, even in the most 
difficult cases. 

Our Reduced Price to Physicians is $5 Eacli. 

Instruments sent by mail at our risk, on receipt of price; or we can send by express, C. O. D., 

and collect return express on the money. 

CAUTION. — Persons re'.niving a Supporter will find, if it is geauiue, the directions pasted in the cover of the box, with 
thf boa.l-line " DR. L. D. McINTOSH'S NATURAL UTERINK SUPPORTER"; a cut on che right, showing the Supporter 
and on the left its application, also the Fac Simile Signature of DR. L McINTOSfl. Each pad of the abdominal beltis stamped 
n gilt letters, DR. McINTOSH'S NATURAL UTERINE SI I'PORTER CO., CHICAGO, ILL. 

Dr. Iclntosli Natiral Dteriiie Snorter Co., 

300 DEARBORN STREET, CHICAGO, ILL. 

<>ur valualile piriiphlet " Some Practical Facta About Displacementg of the Womb" will be »e<nt yon freeoo appUtatioo. 



Advertisements. 



19 




m. k 



"Mixtura Gualaci, et Stillinglae, Comp." 



Kept in Stock in the following 
Wholesale Houses : 

Every Wholesale Druggist in N.Y. City; 
A. McClure & Co., Albany, N. Y ; Geo. C. 
Goodwin & Co., Carter, Carter & Kilham, 
Boston; Moore & Hubbard Drug Co., Buf- 
falo, N. Y.; J. H. Winkelmann & Co., Gil- 
pin, Langdon & Co.. Baltimore, Md ; Wells 
& Kicbardson Co., Burlington, Vt.; Peter 
Van Schaack & Sons, Lord, Owen & Co., 
Morrison Plummer & Co., Chicago, 111.; 
Benton, Myers & Co., Cleveland, O.; .John 
D. Park & Sons, Cincinnati, Ohio; H. Baer 
Charleston, 8. C; Kauffman, Lattimer & 
Co., Columbus, Ohio; The J. W. Crowdus 
Drug Co , Dallas, Tex.; Hurlburt, Hess & 
Co., Des Moines, Iowa; James E. Davis <fe 
Co., Detroit, Mich.; Gerity Bros , Elmira, 
N.Y. ; Hazeltine <fe Perkins Drug Co., Grand 
Rapids, Mich.;Talcott. Frisbie & Co., Hart- 
ford, Conn.; Woodward, Faxon & Co., K. 
C., Mo ; James MeCord, La Crosse, Wis.; 
H. T. Clark Drug Co , Lincoln, Neb ; J. B. 
Wilder & Co., Louisville, Ky., Lamar, 
Rankin & Lamar, Macon and Atlanta, GJa.; 
G W. Jones & Co., Memphis, Tenn.; The 
Charles Baumbach Co.. Milwaukee, Wis.; 
Lyman Eliel Drug Co., Minneapolia, Minn; 
Wells & Calhoun. New Haven, Conn.; I. L. 
Lyons & Co. , New Orleans, La.; Colburn, 
Birks & Co , Peoria, 111.; French, Richards 
& Co., Smith, Kline & Co., Roller & Shoe- 
maker, Phila., Pa ; Geo. A. Kelly <k Co., L. 
H. Harris Drug Co., Pittsburg, Pa; Cook, 
Everett & Pennell, Portland, Me.; Snell, 
Heitshu & Woodward, Portland, Ore.; Geo. 
L. Claflin & Co., Providence, R. I.; C. F. 
Paine & Co., Rochester, N. Y ; Richardson 
Drug Co., St. Louis, Mo , Omaha, Neb., 
Indpls., Ind.; C. W. Snow & Co., Syracuse, 
X. Y.; Lippmann Bros., Savannah, Ga ; 
Noyes Bros 4: Cutler, St. Paul, Minn.; J. 
J. Mack & Co , San Francisco., Cal.; Wal- 
ding, Kinnin & Marvin, Toledo O ; Meyer 
Bros & Co., St. Louis, Mo.,Ft. Wayne, Ind, 
Dallas, Texas; Meyer Bros. Drug. Co., 
Kansas City, Mo. 

For Rheumatism.— '''e have hundreds of testimonials from prominent physicians who have presoribid and personally used this mixtare. 

It Is manufactured for physician's pres .ipttons only. Always specify GRIKFITH k Co. '8. 

If you have an obsiiDate case of Rheumatism on hand, inclose One Dollar and re eive. by sxpress, a regular size boi tit, or we will stnd, npon 
request, a sample bottle, providing you will pay express charges. Wholesale price-list— 8-ounoe size, $10.50 pordozen; '6-ounce size, $20 per dozen. In 
lota of one dozen and upwards we prepay express charges to any point east of the Kocky M' untains. (Do not overlook tbia offer, for yoa may be pleased 
and possibly surprieed at the result ) P. S. — The advertising of this article is confined strictly lo medical journals. 



"NOT A PATENT 

The original and 
pr irate monogram 
also our signature 
printed on the label 

''RELIEF 




MEDICINE" 

genuine has this our 
printed on the label 
at the bottom and 
over the cork. 

CERTAIN" 



This Mixture combines, in a pleasant and aKroeablc form Cuainc. StilUngia, Prickly 
Ash, Turkey Corn, Black Cohxiih, and many other of the well-known remedies for In- 
flammatory, Muscular, Acute, Articular. Pulniouary. and Chronic KHEDMATItiM, 
Gout, Lumbago, and tbe various forms of Neuralgia, affording relief in from twelve to 
twentj'-four hours. In Facial Neuralgia one to Iwo doBes usually eufflce, while at 
the same time it acts aa a powerful Alterative and Plood Purifier. 

Dose for /I<^a//y- Table spoonful 3 to 4 times aday according to severity of the case in 
& little water or milk. Renerally one hour after meals; tbe last dose previous to retiring- 
after two or three days the dose can bo decreased to X tablespoon ful, and by its con- 
tinued use In tea-spoonful d08«s a recurrence of Ihe malady can be prevented. 



ORIGI.NATED AND PKEPAKED ONLV BY 



e^ 




-7^^ ^ 



Chemists and Pharmacists, 

U6 Second Avenue, cor. 9th Si, and 22il Third Avenue, cor. \IU St.. f(. Y. 



OOTT.A.OE 



INCORPORATED 1883 



EiOSIPIT^A-L 



Cor. Second and Fisher Sis. 

Peoria, III. 

An endowed benevolent institution, is very centrally located, has handsome grounds 
and elegant rooms, good nursing, and is under the control of a Board of Directors com- 
posed of representatives from the various religious denominations. 

No insane patients, or persons suffering with any contagious disease, admitted. 

A lying-in department affords benefits to a special class of cases. 

The terms, invariably in advance, will vary according to rooms, but will be made as 
reasonable as possible. 

Private rooms, %! to $10 per week; double rooms, %b to S7 per week. Treatment 
extra, except by special arrangement. 

Any reputable physician can send in and attend his patients, retaining his own practice. 

BOARD OF DIRECTORS. MEDICAL STAFF. 

WM. REYNOLDS, President. 

MAX NEWMAN, Secretary. DR. H. STEELE, 

DR. ROBERT BOAL, ^^- O- B. WILL, 

O. J. BAILEY, DR- T. M. McILVAINE. 

CHA8. QUALMAN DR. .J. S. MILLER, 

B. H. MORGAN, DR. H. KRUSE. 
DR. JNO. L. HAMILTON. 

For further information address Db. JNO. L. HAMILTON, Agent. 



20 



Advertisements. 




Calcium Phosphate with other essential 
inorg-anic tissue formers in a soluble form. 



I TISSUEFOOD. 




A PEERLESS CHEMICO-PHYSIOLOGICAL FOOD AND RESTORATIVE 

WITHOUT A RIVAL IN 

STOMACH DISORDERS, such as Indigestion, Flatulence, Gastric 

Catarrh and Poor Appetite, Constipation, Etc. 
lYRONG-S OF NUTRITION as in Scrofula, Rickets, Caries, Marasmus, 

Delayed Union of Fractures, Necrosis of Tissue, Difficult or Delayed 

Dentition and Development, Etc. 

NERVOUS AND GENERAL DEBILITY AND SLEEPLESSNESS, as 

from Se.xual Excess, Venereal Disease, Childbearing, Nursing, Loss 
of Blood or other fluids, Menstrual and other Diseases of Women, 
Abuse of Alcohol, Tobacco and Narcotics, Protracted Illness, Etc. 

Provident Chemical Works, 

St. Louis, Mo., U. S. A. 
WRIGHT & RICH, Eastern Agents, Write for sample mailed free. 

New York, Mention this journal. 



ca.xjlocore:^. 

The most Important Therapeutic Agent ever Presented to the Med- 
ical Profession in the Treatment of the Diseases of the Feaiale Repro- 
ductive Organs. 



:FOI^Di^TJXl^: 



Caulocorea s composed of the active principles of Caulophyllum Thalic- 
troides, Niburnum Opulus.Prunifolium, Ltioscorea Villoso, Mitchelia Repens, 
Aletris Farinosa, so combined with Spts. jEtheris Comp. and aromatics as 
to form a most perfect and agreeable Elixir, and greatly increase the anti- 
spasmiodic and tonic effect. 



It being a powerful Antispasmodic, is the remedy par excellence in Dysmenorrhcea 
or Threatened Abortion, which every physician will perceive by a glance at the formula. 

We are gratified to know that the intrinsic merit of CAULOCOREA has com- 
mended it to the favor it is receiving at the hands of the Profession. 

DOSE— One tablespoonful three or more times a day, as indicated. 

To Females who are Suhject to Convulsions during Oestation or Parturition, It should 
be given for several weeks previous to the time of the threatened paroxysm, two or 
three times a day, alternating weekly with Bromide Potassium. 

For Dysmenorrhcea, give CAULOCOKEA for a week previous to the appearance of 
the Catamenia. Immediately upon its appearance, should any pain ensue, give It in 
smaller doses every few •^inutes until pain is alleviated. 

In case of Habituci "iortion, give CAULOCOREA as soon as pregnancy is discov- 
ered, and continue unt /, et tation is far advanced. 

CAULOCOREA , put up in Pound Bottles, for Pliysicians' Pre- 
scrij iions only. Price, $1.00 per Bottle. 

TO SE HJLZD JL.T .A-XiX. nDDaTJC3-C3-ISTa 

IPREPARED ONLY BY 

DR. J. W. LOWELL & CO., 

F. V. Portland, Me 
DISTRIBUTING AGENTS, 



MOKKISON. PliUMMER & CO., 
SINGER & WHEELER, 
BICHARDSON & CO., - 
NCYES BROS. & CUTLER, 



Chicago 

Peoria 

St. Louis 

St. Paul 



Hand-Book Sent on JVppli cation to tlie Proprietors. 



Advertisements. 



21 



The only SHOE for the LAME! 

NEW IMPROVED EXTENSION. 

THE ONLY SHOE GIVING A NATURAL APPEARANCE. 




Appearance of persons wear- 
ing our new style. 



Appearance of persons wear- 
ing the old style. 



Call and see for yourself. You c an Walk, Stand an d Look Like a Man ought to Look. 

MANUFACTURER OF 

SURGICAL INSTRUMENTS, APPARATUS FOR DEFORMITIES, ETC., 

410 N. SEVENTH ST., ST. LOOIS, MO. 
Sole Manufacturer of Dr. Rumbold's Instruments. 

REPAIRING OF .ALL KINDS OF SURGICAL IXSTRUMENTS;PR01IPTLY .ATTENDED TO. 




ililij.siwii 







Private Hospital for he Insane. COLLEGE HILL. OHIO. 

Thirteen Year's Successful Operation. One hundred and Fifty Patients Admitted Annu- 
ally. Daily Average Sixty. Cottages for Nervous Invalids, Opium Habit, 
Inebriety, etc Location Solubrious; Surroundings Delightful; 
Appliances Ample; Charges Reasonable. 
Accessible by Rail; 6 Train.s| Daily; 40 minutes from C. H. & D. Dejx't, Cor. Fifth and Hoadley 

FOR PARTICULARS ADOREES < IXCINNATI. 

OI^X^HEXJS EV^^IE^TS, IMT. ID., Supi. College ma, 0. 



Publisher's Department. 



Contempt of Court. — Of all cu- 
rious reading that we have enjoyed in 
some time, we think that afforded by 
a communication from Dr. E. E. Stew- 
art to the current number of the Drug- 
gists' Circular certainly caps the cli- 
max. It affords a splendid illustration 
of the wisdom of the adage which 
advises the shoemaker to stick to his 
last. Whenever a physician strays 
from his own profession into the intri- 
cacies of the law, and especially of the 
patent laws of the country, his feet are 
in dangerous and slippery ground, no 
matter where his head or heart may 
be. In the present paper, Dr. Stewart 
attacks the recent decision of the United 
States District Court in the matter of 
the suit of Battle & Co. against the 
Grosses (Daniel W. and Edward Z.), 
for infringement of their copyright of 
Bromidia. He declares that the 
decision is not final or binding, 
and advises the Grosses and drug- 
gists generally not to pay any at- 
tention to it. Dr. Stewart thus puts 
himself in contempt of the United 
States Courts, and advises others to 
place themselves in the same foolish 
and dangerous predicament. The 
queer part of the matter, however, is, 
that every reason which he advances 
against the validity and justice of the 
decision is the strongest possible argu- 
ment in its favor, and the reader 
must be obtuse indeed not to see that 
it is so. This view was evidently taken 
by the editor of the Circular, who 
says: "While giving Dr. Stewart's 
argument publicity on account of its 
novelty, we think it proper to remind 
pharmacists that they are bound by the 
decision so long as it is allowed to 
stand" — which advice is good, sound 
sense, like pretty much everything that 
emanates from the editor of the journal 
quoted.-^6V. Louis Medical and Surgi- 
cal 'Journal, 'January, i8S8. 



Lectures on Inebriety. — The 
president of the English Society for 
the Study of Inebriety, Dr. Norman 
Kerr, is to give the first course of med- 
cal lectures on the Disease of Inebriety 
and its Treatment, in the hall of the 
London Medical Society, beginning 
Jan. 12, 1888. Dr. T. D. Crothers, of 
Hartford, Conn., has been invited to 
deliver two lectures on the same topic, 
before the Albany Medical College, 
Jan. 24 and 25, 1888. These are the 
first medical lectures on inebriety, and 
the first efforts to present this subject 
in connected detail, by medical men, 
from a purely scientific standpoint. — 
Fro7n Jan. No. Journal of Inebriety. 



Prof. Fauvel on the Vin Mariani. 



13 Rue Guengaud, Paris, Dec. 8, 1887. 
To the Editor of the New York Med. Journal : 

Sir: Will you kindly have it an- 
nounced in your journal, in justice to 
myself before the medical profession, 
that the various notices appearing in 
journals and circulars quoting my name 
in connection with coca are entirely 
false and in every respect a prevarica- 
tion. The only preparation of coca 
erliployed by me with undoubted and 
uniform success has been the so well 
known vin Mariani, which, since 1865, 
I have had occasion to prescribe daily 
in my clinique, as well as in private 
practice. My opinion of this valuable 
medicament, together with those of 
many of my confreres, has during 
many years been frequently made 
known for the benefit of the profession 
in various writings, and it is but just 
to this worthy preparation that it re- 
ceive all honor due. I thank you for 
compliance with request. 

Ch. Fauvel. 



Publisher's Department. 



23 



Antiseptic Treatment of Intes- 
tinal Affections. — ^In an article on 
Intestinal Antiseptics, by D. N. Kins- 
man, M. D., appearing in the 'journal 
of the Atnerican Medical Association^ 
July 3, 1886, the author points out that 
the natural processes of fermentation 
and putrefaction going on in normal 
digestion are so changed in dyspepsia 
and other forms of intestinal disease as 
to produce poisonous alkaloids, which 
are the cause of the symptoms devel- 
oped in such disorders. 

The researches of Prof. Vaughn, of 
the University of Michigan, in which 
tyrotoxicon has been shown to be the 
cause of ice cream poisoning, which 
are still fresh in the minds of medical 
readers, have thrown still more light 
on the etiology of intestinal affections, 
and made apparent the importance of 
intestinal antisepsis as a method of 
treatment. 

To facilitate such treatment, we 
learn that Parke, Davis & Co. have re- 
cently added to their list an Intestinal 
Antiseptic Pill, the formula of which is 
as follows: Mercury Protiodide, 1-8 
gr.; Podophyllin, i-i6gr.; Aloin, 1-16 
gr. ; Ext. Nux Vomica, 1-16 gr. ; Ext. 
Henbane, 1-16 gr. 

Owing to the claims made by some 
parties that they obtain this well- 
known preparation in bulk, it is impor- 
tant that physicians should know such 
are false, as we are informed by the 
manufacturers that Succus Alterans is 
only put up in pint, round amber bot- 
tles. 

This remedy has come into such 
general use by the profession, that 
care should be taken to secure the 
genuine, prepared by Eli Lilly & Co., 
which has given such good results and 
established the reputation it now en- 
joys. — Indiann Eclectic Medical your. 

The Peoria City Societies have 
buckled down to work for the winter. 



Dr. J. S. Miller read a paper on Anaes- 
thesia during labor before the last 
meeting of the Academy of Medicine, 
which elicited a most interesting and 
practical discussion. 

There is nothing more heard this 
winter about the Peoria Medical Col- 
lege, but the subject of a free dispen- 
sary has received considerable atten- 
tion. The arguments f)ro and con are 
those advanced in other cities, and the 
opponents to the plan seem to be in the 
majority. 

I have used Elixir Purgans myself 
and prescribed it for my patients, and 
take pleasure in saying that it is both 
pleasant and agreeable to take and 
effectual in its results, and well adapted 
for either a cathartic, laxative or ape- 
rient. Respectfully yours, 

J. Kendell, M. D. 

Covington, O. 

Cremation in Cases of Death 
FROM Yellow Fever in Brazil. — 
By imperial decree, cremation has been 
made compulsory in Brazil in cases of 
death from yellow fever. The cost of 
the crematorium and other expenses 
connected with the cremation of the 
bodies are to be paid by the community. 
— The Konsas City Med. Record. 

I have used Succus Alterans in both 
primary and tertiary syphilis during 
the last two years with the most grati- 
fving results. To the general practi- 
tioner of medicine it is a veritable de- 
sideratum. Yours truly, 

P. A. Gordon, 
Junction City, Perry Co., O. 

The spring meeting of the Military 
Tract Medical Society will be held in 
Peoria, of the time due notice will be 
given and the program published. 

We hope there will be a large at- 
tendance from the central part of the 
State. 



P EACOCK'S B ROMIDES 

(SYR: BROM: COMP : PEACOCK) 

NERVE SEDATIVE, 

Each fluid drachm represents 15 grains of the Combined C. P. Bromides of 
Potassium, Sodium, Calcium, Ammonium and Lithium. 



USES:-EPILEPSY, and a!! CONCESTIVE, 
CONVULSIVE, and REFLEX NEUROSES. 



This preparation has stood the test of time and experience, 
and can be relied upon to produce results, which can not be 
obtained from the use of commercial bromide substitutes. 



DOSE: — One to two FLUID drachms, in WATER, three or more times a day. 

P EACOC K CHEMICAL CO., St. Louis. 

Or. Jerome Kidder's 
♦ELECTRO- 
MEDICAL 
APPAEATTJS! 




Awarded Medal of Supe- 
riority from the American 
Institute for Fourteen Con- 
secutive Years. Highest 
Award wherever exhibited 
in competition 

Cold Medal from 

Atnerioan Institute in 1875. 

Silver and Bronze 

Medals from the Ameri- 
can Institute, the Highest 
Awards, from 1872 to 1876 
inclusive, for the Best Ap- 
paratus either here or 
abroad 

Bronze Medal and 

First Premium. Centennial 
Exhibition. 1676. 

Silver Medal. High- 
est Awiird from Charleston, 
y.C, Kxhibition.fall of 188i. 

Five Silver Medals 

from Cincinnati Industrial 
Exposition, fall of 1881, 1882 
and 1883. 

Bronze Medal from 

Southern Exposition, at 
Ix)uisville, Ky . fall of 1883. 
To distinguish the genu- 
ine from the Spurious, send 
for a copy of the ' 'Electro- 
Allotropic Physiology," 
mailed free. 

Jerosie Hidder Uanf. Co. 

820 Broadway, N. Y. 



Advertisements. 25 



f 



BOVININE 

DBUSHL'S F"1^XJII> I^OOI>, 

CONTAINING 34.70 PER CENT. OP SOLUBLE ALBUMINOIDS. 

The vital princioles of Beef and Mutton concentrated. A. highly condensed Raw 
Food|Extract. Acceptable to the most delicate taste and smell. Does not 
become putrid in a short time as all other raw foods do. Retained 
by irritable stomachs that reject all other Foods. It assimilates more 
readily*thani;any other Food known to the Medical Profession. BO- 
VININE under the microscope shows the blood corpuscles in 
their normal condition strongly marked, while in all other 
Foods or Extracts this vitally important element 
is destroyed by the action of heat in cooking. 

In Typhoid Fever the patholigical conditions present in the large and small intestine about 
the ileo-coeeal valvei|from the inflammation and suppuration of the agminated and solitary 
glands demand a food containing no excrementitious matter, while the depressing effects of 
the disease upon the vital powers through the nervous system makes a highly nutritious and 
stimulating food absolutely necessary. 

These indications for a food are met in Bo\-inine, which contains all the albuminoids of 
Beef and Mutton in a very concentrated form, unchanged by heat or chemicals, as well as its 
stimulating meat salts. The process of its extraction also insures perfect freedom from extra- 
neous substances. 

Bovinine alone, or as an adjutant to the milk diet ordinarily employed, is of the greatest 
benefit in either the acute stage of the disease or during convalescence from it, as it is readily 
borne by the ^veakest stomach, and is acceptable to the taste of every patient. 

In the vomiting of pregnancy the extreme difficulty of nourishing the patient is obviated 
by Bovinine given in small doses frequently repeated. This symptom of reflex action cannot 
always be entirely controlled, but its frequent recurrence is diminished, better nutrition as- 
sured, and the dangar to life from inanition averted. 

In all cases where rectalalimentation is necessary, no more eligible food preparation can 
be found than Bovinine. Reports of several cases are at hand showing increase of strength and 
weight in patienis nourished for weeks upon Biviniue exclusively, administered in this mann er. 

In Diphtheria, a disease characterized by extreme prostration and rapid failure of the 
vital powers where there is the mo,st marked indication for a stimulating diet capable of 
bringing almost instant response, Bovinine is a most reliable food, its concentration and flu- 
idity recommending it on account of the local lesions in and about the pharynx, while its nu- 
trient value is demonstrated by its adaptation to the excessive prostration incident to the 
disease. 

In disturbances of the intestinal tract accompanied by gastric irritation: in cancer of the 
stomach orrectum; in supplying the waste of albuminuria,- in the marasmus of infancy or old 
age;- in scrofulous conditions; in phthisis, and in so-called dyspeptic conditions, Bovinine will 
be found of signal service, securing better nutrition and assimilation, and alleviating the con- 
ditions present. Bovinine is a raw food and is neither partially nor whilly digested, so that 
Wben given in cases of enfeebled digestive powers, it does not still further increase the inabil- 
ity of the gastric forces to perform their work, but restores them by its physiological stimula- 
tion to their normal effectiveness. 



Memphis, TEjfjr., 26th January, 1887. 
The J. P. Bush Manufacturing Cc, 3 Barclay St., N', Y. City; Gentlemen: 

In reply to your note of luquiry regarding Bovine, I can say that I have very recently op- 
erated on a patient in which case it was necessary to prevent action of the bowels for 8 or 9 
days, meantime to furnish nutrition and support the system. 

I ordered for that purpose Bovinine, taken in fresh, sweet milk, and I must say that in a 
surgical experience of uotv nearly 30 years, I have never had anything to give me such satis- 
factory results. I wish every surgeon and physician viewed its great nutritive qualities as I 
do, for, although this was a "test case,'' it is not the only one that has served to show me its 
axe merit as a nutrient. Very truly , etc., 

J. P. McGEE, M. D., Surgeon, etc. 

I have been prescribing Bovinine in my practice for some time, and am highly satisfied 
with the results. In one case of Typhoid Fever, where every other nourishment was rejected, 
the Bovinine ■was retained, and, 1 feel confident, saved my patient. 

John Milton Duff. M. D., 
Protessor of Obstetrics in the Western Pennsylvania C!ollege. 

Gentlemen: We have used your Bovinine extensively in this institution, with very satis- 
factory results. Its beneficial influence has been especially marked in cases of Typhoid Fever. 

"DETROIT SANITARIUM." 
F. W. Manx, Resident Physician. 

CAREFULLY PEEPARED BY THE 

J.F.Susii Ml Coni!}'nv,i2 a&dii Third Ave.CIiicago! 2 Barclav St. Astor Bouse, U 



26 Advertisements. 

DURING THE WINTER 

Nearly every physician has patients daily where Cod Liver Oil and 
Hypophosphites are indicated. To all such, who are not using 

SCOTT'S EMULSION 

OF PURE NORWEGIAN 

OOID XjiI"\7"E!I=l OIXj 

"WITH 

HYPOPHOSPHITES OF LIME AND SODA, 

We would he pleased to have them send to us for a sample, which 
we will gladly deliver by express or post paid. SCOTT'S EMUL- 
SION is nearly as palatable as Milk, and will not separate or 
(flange; thus each dose is alike. 

(50% of Pure Cod Liver Oil. 
FORMULA : 1^ Cirains Hypophosphites of Lime. 

(3 Grains Hypophosphites of Soda, to a Fluid Ounce. 



SCOTT & BOWNE, Mfg. Chemists, 

132 and 134 South Fifth Ave., New York City. 
WHEELER'S TISSUE PHOSPHATES. 



Bone-Calcium Phosphates Ca 32 P. O. 4, Sodium Phosphate Na 2 H. P. O. 4, Ferrous 
Phosphate Fe 32 P. O. 4, Trihydrogen Phosphate H. P. O. 4 

Wheeler's Compound Ei.ixr of Phosphates and Calisaya. A nerve food and 
Nutritive Tonic, for the treatment of Consumption, Bronchitis, Scrofula and all forms of 
Nervous Debility. 

The Lactophosphates prepared from the formula of Prof. Dusart. of the University of 
Paris, combines with a superior Permatin Sherry Wine and aromatics in an agreeable 
cordial easily assimilable and acceptable to the most irritable stomachs. 

Medium medicinal doses of Phosphorus, the oxidizing element^of'the NerveiCenters 
for the generation of Nerve Force; Lime Phosphate, an agent of Cell Development and 
nutrition ; Soda Phosphate, and excitant of functional activity of Liver and Pancreas, 
and Corrective of Acid Fermentation in the Alimentary Canal ; Iron, the Oxidizing Con- 
stituent of the Blood for the generation of Heat and Motion ; Phosphoric Acid. Tonic and 
Sexual Debility ; Alltaloids of Calicaya, Anti-Malarial and Febrifuge; Extract of Wild 
Cherry, uniting with tonic power the property of calming Irritation and diminishing 
Nervous Excitement. 

The superiority of the Elixir consists in'uniting'withjthe Phosphates'the'special prop- 
erties of the Chinchona and Prunus, of subduing fever^ and allaying Irritation of the 
Mucous Membrane of the Alimentary Canal, whicd adapts it to the successful treatmeat 
of Stomach Derangements and all diseases of faulty nutrition, the outcome of Indiges- 
tion, Malassimilation of Food.fand failure of supply.of these essentialielements of Nerve 
Force and Tissue Repair. 

The special indication of this combination of Phosphates in Spinal Aflfections, Caries, 
Necrosis, Ununited Fractures, Marasmus, Poorly Developed Chi'dren. Ketarded Denti- 
tion, Alcohol, Opium and Tobacco Habits, Gestation and Lactation to promote Develop- 
ment, etc, and as a physiological restorative in Sexual Debility, and all used-up condi- 
tions of the Nervous System should receive the careful attention of eood therapeutists. 

There is no strychnia in tliis preparation, but when indicated, the Liquor Strychnia 
of the U. S. Dispensatory mav be added, each fluid drachm of the solution to a uo'und of 
the Elixir maiiing the 64th of a grain to a half fluid ounce, an ordinary dose, a combina- 
tion of a wide range of usefulness. 

DOSE— For an adult, one tablespoonful three times a day, after eating; from seven to 
twelve years of age, one dessertspoonful; from two to seven, one teaspoonful ; for infants 
from five to twenty drops, according to age. 

Prepared at the Chemical Laboratory|of T. B. Wheeler, M. D., Montreal, D. C 

Put up in pound bottles and sold by all Druggists, at One Dollar. 



Fellows' Hvoo-Phos-Phites 



(StU; livPOrUOa: COMP: FALLOWS) 

Cyutaim- TJl8 SSSCatlal Elements to the Auimal Orgauiaa- 
tioii — Potash ami lime ; 

The OlTdizinj? A^eatS— Iron and Manganese ; 

The Tonics — Q.uiuine and Stryehniue ; 

And the Vltaiizifl^ ConstltQeUt— Ph(jsphoru3, Comhiued in tk« 
fbnn of a Synip, with Slight Alkaline lifodion. 

U Differs In Effect from all others, being pleasant to tast*, 

acieeptable to the stomach, and harmleas under prolonged use. 

It has sastained a hij^h EcpUtatiOa in America and England 
ft)r efficiency in the treatment ot' Puhnonary Tuberculosis, Chronic 
Bronchiiig, and other affections of the respiratory organs, and b em- 
ployed alio in various nervous and debilitating diseases with success. 

Its CliratiTe FropertleS are largely attributable to Stimulant, 
Tonic, and Nutritive qualities, whereby the various organic function* 
tre recruited. 

Ifi Cases where innervating constitutional treatment is applied, 
aad tonic treatment is ilesirable, this preparation will ba found to act 
with safety and satisfaction. 

Us Actloa is Prompt, stimulating the appetite, and the dig€«- 
tion, it promotes essimilation, and enters directly into the circuUtion 
with the food products. 

The Prescribed Dose produces a feeling of buoyancy, removing 
viepressiou or melancholy, and hence is of great value in tne treatmeni 

of mental and aerroas affections. 

From ita exertiag a double tonic effect and influencing a healthy 
&)iv <if the .secretJoui, ir.s use is indicated in a wide range of diseases. 

Prepared by JAWES I. FELLOWS. Chemist, 

4=8 VEiSE]^ ST., lNrE3"W ITOK-IC. 

Circulars sent to Pb78iciaQ8 on A.ppUoation. 



FOR SALE BY ALL DRUaG-ISTS. 



t^6Ci9A94<$^<^49>i^^^'&®^^E>i^i»>kys>;^<^)^^ 



COLDEN'S 
LIOU" 



E 



aiAIfiii&Tiftr;^*!." 




Aji luvalmable Aid in the Treatment of aU. Cases of Debility. 

, /^OLDEN'S LIQUID BEEF TONIC «>Hrff.i3 of the Extract o/ Beef (by Baroa Licbig's ^rec«K^). spiiU re^icrwi ■•n-iBii»< 
1/ to the mast delicjaestoniicH by exti-acti»» of I''uscl Oil, soluble Citrate of lien, CLnclKina. GoBtiaa, sta^ siBii»le ai»mai ic» Aj 
1 offiifial analysis of this prtriaraiion by theemiii':nt chtnnlst ARTHUR MILL HAfSALL, M.R., F.R.a,a«d i^emiwntmmt ii 
iSIJl ERASMUS Wri.'.-ON.K.R 5.,ispruu8d«mthcIibdof eachbgtik. 

Im th« ti-«atBB«at. of •!! oasea of D«bilUr. CoBralesoanc* from satat* UIbass, Axucinia. tfalAriftl r*T«r, 
Cklerosis, luoipieat, ('oa«umpHoa, Lack of NerT« Ton*, »md of ti»« Alcohol *m«l eFinaa Mjklrtfi, »>«l «'n{ 
^imti\»di»t r«qu!ii»5 » Tonie Kntri»»t, it it tuporior to all otkor pro{i«rj|$i*as. 

f^ It acls (iii--ctly •• li-.'^seniisnt tastric Ti-n-»s, stimulatiaj the follid«s to scci-eiicm, and jivee t* wtakcned iniivi«iuals thii fi>>« 

Brarequisite to improf emc(jt, an ati petite. — 4^ By thotiv2Cat reqtttst of scvaij eminent members ef th« mediod pr*fosSi«a, I l8a*«1 
:«3iJed toesuA wineelawfol «f this preparation ttta jratos of SOLUBLE CITRATE OF IROK.aiwl ▼.■hich is ScsJiBaied e»ti%i 
j.^ label, WITH IRO^., "No. !;•' u-hile the same ?repa>ation, WITHOUT IROX, is dosisoaicd cm the Jabel as "Mo. 2." 

*arX ti>m, xtwumppUcmHon, s*ndmtmmpl« hoHl* of COLDEN'S LIQUID BEEF TONIO f mny phyat- 
>#t«n it* r0gitltrr stmnmng. in^mitm «»7* your jOUtjtsnstiijf Itniggist {if ft* hm nM mtrMKtip « *mfPh» *• 
'mrd^r^iU In pr«»»r(ktny f1ii» pr0^mrmii»n, physitsimns sTcnld b» parti^nfMr f* mma»n "cOLDEN't," 
*t^^, EXT. CARNI8 FL. COMP. (GOLDEN)." Jt. i» pttt up in pint b*ttU^, mni CAN BE HAD OF WHOLE-^ 
[•ALE AND RETAIL DRUGGISTS GENERALLY THROUGHOUT THE UNITED STATES. 

C. N. CRITTENTON, Sole Affont, 115 Fulton St., Ne-tr Tork. 



GLENN'S SULPHUR SOAP. 

AH yhysIciaciB ka^v.- the great value ef the local u:=e •f 
■Sulphur U the TREAT.MENT OF DISEA.SES OF THE 
= SK1N. GLENN'S SULPHLTR SOAP is the ORIGINAL 
[aud BEST o«mbination of its liind, and the •»« now generally 
iiscd. Far sale by all Dnigjists at 9» c«ats a cake, or three 
I Gttlcas f»r SO c«ois. Be»,-iire of coiaterfiBits. 

"VrUoloiaU X>opot, C. N. CKI'l'TEN 

' PW»« »i««ti«Q T«jfi J0WR.VAJ. *»*Satt.,.!es of abov 



CONSTANTINE'S PfNE TAR SOAP, 

BY FAR THE Bt-':ST TAR SOAP I\LVDE. Has V««i« 
•atrial atnong physlcrans for ver/ many years as a. toil*; »eai»^ 
and healing agent, and its superior virtue have bom WMurf-' 
inousiy conceded in ALL CASES WHERE THI MSt, OT{ 
TAR^ n INDICATED. ' 

L'nsolicited expressions ©f its excellence bav» b«ao rcMivsA^ 
frotB the ilcdical Faculty generally. N»ne gMRiftw velaii 
stamped "A. A. Constantine*s Persian HeaU«g P«« Tw SMr>' 
Fot sale by all Dragglsts, 



TON, lir, ]^n«n glroot. Now Tork. 

e Soaus ^ts.mt fkic on appliuttieD to any phyaickui < 



; a*!^^ 



^UTHIATED ir HYDRANGEA.^ 



KDNEY ALTKRATIVB-ANTILITHIC. 

FOftitH.A.-H^^ A«l<1 (}r»(4im of "Utiibttod Hr^Mweo" rt^^nmtjm thirty rnUtia of fYmK Wf 
drangea a.n4 Uir»e trraint of ehfrnioailv pwr« Brnao-BiUU7i»te of LilblA. Pr«p(u«4 hy •■> 
knproTod p<ro««M oi aecMMile. it ia McortrMy of deJinU* mtA Mo^aroi tb«MipoaM« atwiimtk, 
ttod hawoe a»i^ LtCidependod ut>on Ixi oimkyU pa*ctioe. 

DOS,— Onolov.tavo XeatfioootnU taoj Uvam a cioy ( jutJ eo a My ba tw i tju mp>>aV 

U»iiierT Calculus. Gout. Rhenmaflsn. Brij^ht'a Di8*a«6. Diabete*, OynttiM, 
HsomAtario. Albuminuria, ami Ve^^ical IrritatioDe Oen^n^ly. 



yjLT B Wkve h»d prcp«Med <br tt>a (MnTCBilmce of 
** Pb7Bici»us Cietetk) Sot«, vosiic'tiBff Uie m4- 
oloa of food to he aik>wod or proliibited in cevoaal c>f 
(koM dioeioocs 

Thooe Dietetic Hakr* Itovo b«<r«i biMKid tai the foam 
o^ aniall p«rfor»tod slipe for P)i7Bici&RS %o diatributo 
to tbeir patients. Mftilod gratia upon request, toffetb- 
er with oat latest compilation of oaee reports ai>d 
atiuical obaervationa, be«Birtg us>on Mm t*eaUne»t of 
ftiifl daaa o^ diseftaea. 



KHKUMATWM. 



D' 



ilETETIO HOTE.-A frtttaBd ^rtttt^ 

Me di«t 1« moat favortiMe for puUuii> 
vitb clirooic rhpomat^' trooblca. 

^Rotnad.— Beef and mnttan tn moAarv 
Oon, with hors»-radl«b aa a rellsk; flab tad 
efga, green Tefretableeand fmit, eapadaUy 
kmons. The Bklmmed milk diet baa boa* 
adroootad by aome aotbora. 

Aroid-Stttby and aaoc^Mitea tei^ 
•11 Bult llqtioni, viDea aod ooAae. 



LAMBERT PHARMACAL COMPANT, 116 Olive Street, ST. LOUia